For Profit Managed Care for Long Term Supports & Services Lessons Learned

Size: px
Start display at page:

Download "For Profit Managed Care for Long Term Supports & Services Lessons Learned"

Transcription

1 For Profit Managed Care for Long Term Supports & Services Lessons Learned Mike Chittenden, The Arc Nebraska Kevin Fish, The Arc of Sedgwick County Carrie Hobbs Guiden, The Arc Tennessee John Nash, The Arc North Carolina Dan Ohler, OPTUM 1

2 Learning Objectives 1. How managed care for Long Term Services & Supports (LTSS) is being implemented in other states 2. What is working and not working in managed care for LTSS 3. Best practices around implementation of a managed care system for LTSS 4. How stakeholder input can drive the process of developing and implementing managed care for LTSS 2

3 Kevin Fish The Arc of Sedgwick County (Wichita, Ks) 3

4 Medicaid Managed Care Innovations in the Public Sector Marketplace Dan Ohler, VP State Government Programs 4

5 Opening Thoughts The First Law of Improvement: Every system is perfectly designed to achieve exactly the results that it gets. Donald Berwick, former Administrator, CMS If you want to know what an organization values, analyze how they spend their money. Dr. John Camealy, Professor, Xavier University 5

6 IDD Market Overview Public Spend What are I/DD Services? Recent / Current Market Environment Market Drivers Annual Federal + State + Local I/DD (non-acute/medical) Spend of $61+ Billion Intermediate Care Facility (ICF/ID) Costs associated with providing care (acute and other) to individuals with I/DD in a segregated, institutionalized setting. Home & Community Based (HCBS) Waiver Costs associated with providing needed supports and services (non-acute) in an integrated, community setting. Other Primarily state and local, which may include administrative functions (e.g., case management) i. Fee For Service; cost-based; fragmented, no national model ii. Large un-served qualified population due to budget constraints (waiting list) iii. Inefficient / Inconsistent provision of services and supports i. DOJ activity to enforce ADA/Olmstead & reduce waiting lists (access) ii. New CMS Settings HCBS Final Rule (community driven) iii. Escalating costs driven by more individuals entering the I/DD system of care I/DD Annual Public Spending ($Billions per annum) $16.8 $13.1 $31.6 HCBS Waiver ICF/ID Other I/DD Population (thousands) HCBS Waiver Participants HCBS Waiver Waiting List State-operated ICF/ID Other ICF/ID $200,000 $175,000 $150,000 $125,000 $100,000 $75,000 $50,000 $25,000 $- Avg. Cost by Setting (PMPY) HCBS Waiver Institutional / ICF 6

7 The I/DD Marketplace There are approximately 7M individuals in the United States with an Intellectual and/or other Developmental Disability More than 60% rely on Medicaid for their health care coverage An estimated 80% are Medicaid eligible Nearly 75% live with family members Just over 1M receive formal services from an I/DD agency Total public spend for I/DD in the U.S. exceeds $61B There is a high level of health care utilization for people with I/DD Co-occurring mental illness: 33% Soars to 50% when including substance abuse Cardiovascular disease: 38% Central nervous system diseases: 28% Three or more chronic conditions: 45% Sources: Thomas Cheetham, MD; Kennedy Center, Vanderbilt University David Braddock, Coleman Institute, University of Colorado 7

8 HCBS Waiver Data There are over 250 waiver programs in operation in the United States Over 685K waiver participants with I/DD in FY2013 HCBS waiver enrollment has doubled since FY2000 In excess of $30 billion for HCBS waiver services in FY2013 The average expenditure per person is nearly $46,000 Medicaid represents 77.7% of all I/DD spending: 66% is Home & Community Based Services 27% is ICF/ID (i.e., Institutional) States are continuing to move toward greater expenditures on community versus institutional services: 53% of total I/DD spending is on HCBS vs. 24% for ICF/ID $18.3B of federal funds for HCBS vs. $8.3B on ICF Source: State of the States in Developmental Disabilities; Coleman Institute, University of Colorado (2015) 8

9 Yet for Many, They Wait Despite the growth in HCBS programs nationally More than 320K people are on Waiver Waiting Lists. Texas leads the nation with over 100K on a waiting list Many states report wait lists at more than ten years The real number is likely much higher as not every State maintains a waiting list; Not to mention many families have given up. State budget cuts have also curtailed growth in HCBS. 9

10 The Medicaid Marketplace Last year, Medicaid turned 50! 73M Americans are covered by Medicaid 22.9% of the population California the highest at 12.7M; Montana the lowest at 136K 6.3M additional people have enrolled in just the past year During expansion, 1 in 20 have joined the Medicaid rolls NY, TX, FL rank 2, 3, 4 after CA 48 States use Medicaid Managed Care for healthcare services 28 States also include managed long-terms services & supports 70% of Medicaid enrollees are covered by private Managed Care plans, which translates to 51.3M Medicaid beneficiaries Private Managed Care plans added 7.8M beneficiaries last year Source: The Still Expanding State of Medicaid in the United States; PriceWaterhouseCoopers, November

11 Medicaid Health Plans There are 194 private health plans now in the Market Medicaid continues to be local (i.e., to a State) Only 8 plans, or 4%, operate in more than 4 states 175 plans, or 90%, operate in a single state Private plans are primarily managing physical health benefits Behavioral Health carve-outs were once quite popular, but are now trending toward full integration with PH Integration in KS, IA, LA, TN Carve outs remain in MI, PA, WA I/DD largely remains the last frontier when it comes to MMC AZ, NJ, TN, TX for acute care only; NE in Jan 2017 IA, KS and TN the only states with full MC AZ, NE & TX all in process for full integration Source: PWC, Nov

12 So, why Managed Care? States are looking for full integration holistic services across the service spectrum Large number of people with I/DD also have a BH diagnosis BH & PH services already included in Medicaid Managed Care High number of beneficiaries are Medicaid eligible and/or enrolled in Medicaid programs Many States have identified their service systems as unsustainable Managed care provides opportunities to focus on access, cost containment initiatives and quality health outcomes MCOs building expertise in serving complex populations 12

13 I/DD Comprehensive System of Support Network Development Recruit/develop, train, support monitor and audit: Residential and Day providers Peers Vocational Resources Crisis Management Transportation Community Transition Person Centered Planning Community Based Residence Care Coordination Functional Assessment Specialized IT System with community record Quality Develops/manage overall quality plan including: Incident report monitoring Compliance with PCP Individual satisfaction measurement to assure personcentered services National Core Indicators Conducts regular provider audits to ensure all quality and safety requirements met I/DD Institution Medical Behavioral Pharmacy Dental Vision ID & Strat for complex case management * HCBS Home and Community Based Services + Person Centered Plan 13 Care Coordination I/DD Network Support Assures adequate network resources have I/DD Experience Clinical services IP/OP/IOP

14 Strategies for Approaching Managed Care Be proactive; do not let it just happen to you There are many models of Managed Care Perhaps your State will explore Managed Care Lite Engage the State Medicaid Agency in conversation Get a seat at the table; be prepared; do not be an obstructionist Gather other system stakeholders and work to develop a common ground on key components for your State Meet with Managed Care Organizations Find out what they value; what their key drivers are Ask them who their SMEs are; who their Advocates are The MCOs did not decide to bring Managed Care to your State Talk to colleagues in other states Find out what works and what needs improvement Be open-minded; assume positive intent 14

15 Managed Care Entities They can (and do) co-exist with current system stakeholders Develop Strategies for Collaboration Define Roles Commit to Working Together Develop Common Goals and Shared Outcomes Access; Quality of Care Remember: It s not about us, it s about enhancing the lives of individuals with I/DD 15

16 John Nash The Arc of North Carolina 16

17 Managed Care Principles: Assumptions System designs must start with the individual service recipient It must be a strong, sustainable, personcentered approach to health and long term services and supports The administrative structure must be designed to be highly efficient, cost effective and most of all accountable 17

18 Managed Care Principles: Assumptions Individuals with I/DD are valued members of their families and communities Less concerned with who manages the system than how the system is managed The system must be innovative and flexible 18

19 Managed Care Principles: Assumptions We will work with the administration, the legislature and other stakeholders to design the best system possible Systems are not evil they do what they were designed to do, even if that isn't what we intended there must be room to adjust! 19

20 Managed Care Principles: 1. Self-direction 2. Outcome- based reporting 3. Cost efficiencies cannot be achieved on the back of individuals with disabilities living in the community 4. Accountability 20

21 Managed Care Principles: 5. Integrated care must not be based on a medical model 6. Sub- capitation and payment reform 7. Health promotion incentives for individuals with disabilities must be a part of any benefit plan offered by the system 8. Managed care networks must not require provider exclusivity 21

22 Managed Care Principles: 9. Transition to a new system must be seamless 10. Statewide IT and payment systems must be a part of any system design 11. Reduce the waitlist 22

23 Carrie Hobbs Guiden The Arc of Tennessee 23

24 History of Managed Care in Tennessee Tennessee s entire Medicaid program (TennCare) is an 1115 waiver TennCare has used a managed care model for Health/medical care since 1994 Behavioral health since 2007 LTSS for people who are elderly or who have physical disabilities since 2010 (CHOICES Waiver) TennCare has had its share of struggles along the way for a full history of the program review the TennCare Timeline: 24

25 Tennessee s Employment and Community First (ECF)CHOICES Waiver ECF CHOICES opened for enrollment on July 1, 2016 ECF CHOICES will provide LTSS for both children and adults with intellectual disability (ID) and developmental disabilities (DD) other than intellectual disability (previously only people with ID were eligible for waiver services) ECF CHOICES is administered by TennCare and managed by three (3) Managed Care Organizations (MCOs): BCBS, Amerigroup, United Healthcare These three (3) MCOs also hold the contracts for medical care, behavioral health, and LTSS for people who are elderly or who have physical disabilities (CHOICES Waiver) 25

26 Tennessee ECF CHOICES Waiver continued: Eligibility requirements: Must have ID/DD Meet NF LOC or be at risk of institutional placement Meet financial requirements Three benefits packages (see handout) $15,000 (children and adults) $30,000 (adults) $45,000-$153,000 (adults) 26

27 On the Horizon: Managed Care and Outcomes Based Payments TennCare is moving towards outcomes based payments for medical services and LTSS TennCare has implemented its QuiLTSS project for nursing facilities Stakeholder group began meeting in 2014 Project implemented in 2015 bridge year Full project implementation 2016 QuiLTSS in process for HCBS much more challenging 27

28 Michael Chittenden The Arc of Nebraska 28

29 29

30 For Profit Managed Care for Long Term Supports & Services Lessons Learned Questions? Mike Chittenden, The Arc Nebraska Kevin Fish, The Arc of Sedgwick County Carrie Hobbs Guiden, The Arc Tennessee John Nash, The Arc North Carolina Dan Ohler, OPTUM 30

Medicaid Managed Care. Long-term Services and Supports Trends

Medicaid Managed Care. Long-term Services and Supports Trends Medicaid Managed Care Long-term Services and Supports Trends Medicaid Managed Care Statistics As of 2011, 74.2% of Medicaid Enrollees were enrolled in a Medicaid Managed Care system As of 2011, California,

More information

Medicaid Managed Care 2012 Fiscal Analysts Seminar August 30, 2012

Medicaid Managed Care 2012 Fiscal Analysts Seminar August 30, 2012 Medicaid Managed Care 2012 Fiscal Analysts Seminar August 30, 2012 National Conference of State Legislatures Neva Kaye Managing Director for Health System Performance National Academy for State Health

More information

Medicaid Experts 11/10/2015. Alphabet Soup. Medicaid: Overview and Innovations PPO HMO CMS CDC ACO ICF/MR MR/DD JCAHO LTC PPACA HRSA MRSA FQHC AMA AHA

Medicaid Experts 11/10/2015. Alphabet Soup. Medicaid: Overview and Innovations PPO HMO CMS CDC ACO ICF/MR MR/DD JCAHO LTC PPACA HRSA MRSA FQHC AMA AHA Medicaid Experts DEVELOPING NEW STATE LEGISLATIVE HEALTH LEADERS Medicaid: Overview and Innovations While I can explain the meaning of life, I don t dare try to explain how the Medicaid system works. CMS

More information

A Snapshot of Uniform Assessment Practices in Managed Long Term Services and Supports

A Snapshot of Uniform Assessment Practices in Managed Long Term Services and Supports A Snapshot of Uniform Assessment Practices in Managed Long Term Services and Supports California Department of Health Care Services, Home and Community Based Services Universal Assessment Workgroup February

More information

New York Children s Health and Behavioral Health Benefits

New York Children s Health and Behavioral Health Benefits New York Children s Health and Behavioral Health Benefits DRAFT Transition Plan for the Children s Medicaid System Transformation August 15, 2017 DRAFT Transition Plan for the Children s Medicaid System

More information

Strengthening Long Term Services and Supports (LTSS): Reform Strategies for States

Strengthening Long Term Services and Supports (LTSS): Reform Strategies for States Advancing innovations in health care delivery for low-income Americans Strengthening Long Term Services and Supports (LTSS): Reform Strategies for States March 6, 2018 Michelle Herman Soper and Alexandra

More information

NC TIDE SPRING CONFERENCE April 26, NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver

NC TIDE SPRING CONFERENCE April 26, NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver NC TIDE SPRING CONFERENCE April 26, 2017 NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver Agenda Medicaid Landscape NC Medicaid Transformation Supporting Legislation

More information

Medicaid: Current Challenges and Future Prospects

Medicaid: Current Challenges and Future Prospects Medicaid: Current Challenges and Future Prospects Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation Executive Director, Kaiser Commission on Medicaid and the Uninsured The

More information

NC TIDE 2016 Fall Conference November 14, Department of Health and Human Services NC Medicaid Reform Update

NC TIDE 2016 Fall Conference November 14, Department of Health and Human Services NC Medicaid Reform Update NC TIDE 2016 Fall Conference November 14, 2016 Department of Health and Human Services NC Medicaid Reform Update Agenda National Medicaid Landscape Medicaid Transformation in NC 1115 Waiver Process NC

More information

ABC's of Managed Care and What It Might Mean for Home & Community Based Services

ABC's of Managed Care and What It Might Mean for Home & Community Based Services ABC's of Managed Care and What It Might Mean for Home & Community Based Services This project is supported by a grant from the Pennsylvania Developmental Disabilities Council. David Gates DGates@phlp.org

More information

Welcome and Introductions

Welcome and Introductions Integrating Care for Dual Eligible Beneficiaries National Conference of State Legislatures Fall Forum: Changing Roles of States in Long Term Services and Supports December 3, 2013 Sarah Barth, JD www.chcs.org

More information

The benefits of the Affordable Care Act for persons with Developmental Disabilities

The benefits of the Affordable Care Act for persons with Developmental Disabilities Tuesday, 2:30 2:00, B5 The benefits of the Affordable Care Act for persons with Developmental Disabilities Objectives: Notes: Audrey E. Smith, MPH 33-402-9608 Asmith2@waynecounty.com. Identify effective

More information

Rehabilitation Research and Training Center on Aging with Developmental Disabilities Department of Disability and Human Development University of Illinois at Chicago http://www.rrtcadd.org/ By 2010 Managed

More information

Medicaid Reform: The Opportunities for Home and Community Based Providers. All Rights Reserved

Medicaid Reform: The Opportunities for Home and Community Based Providers.     All Rights Reserved Medicaid Reform: The Opportunities for Home and Community Based Providers ILS Background & Experience Care Management Company founded in 2001 Focuses on Duals, Medicaid ABD and Managing Medicaid Long term

More information

Opportunities to Advance Lifespan Respite: Managed Long-Term Services and Supports and Affordable Care Act Options

Opportunities to Advance Lifespan Respite: Managed Long-Term Services and Supports and Affordable Care Act Options Opportunities to Advance Lifespan Respite: Managed Long-Term Services and Supports and Affordable Care Act Options October 18, 2013 Joe Caldwell Director of Long-Term Services and Supports Policy 1 Overview

More information

Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States

Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States Erica L. Reaves, Policy Analyst State Variation in Long-Term Services and Supports: Location, Location, Location National

More information

Medicaid and CHIP Managed Care Final Rule MLTSS

Medicaid and CHIP Managed Care Final Rule MLTSS Medicaid and CHIP Managed Care Final Rule MLTSS John Giles, Technical Director Division of Quality and Health Outcomes Children and Adult Health Programs Group Debbie Anderson, Deputy Director Division

More information

2016 Edition. Upper Payment Limits and Medicaid Capitation Rates for Programs of All-Inclusive Care for the Elderly (PACE )

2016 Edition. Upper Payment Limits and Medicaid Capitation Rates for Programs of All-Inclusive Care for the Elderly (PACE ) 2016 Edition Upper Payment Limits and Medicaid Capitation Rates for Programs of All-Inclusive Care for the Elderly (PACE ) R ABSTRACT The Program of All-Inclusive Care for the Elderly (PACE ) is a federal

More information

Figure 10: Total State Spending Growth, ,

Figure 10: Total State Spending Growth, , 26 Reason Foundation Part 3 Spending As with state revenue, there are various ways to look at state spending. Total state expenditures, obviously, encompass every dollar spent by state government, irrespective

More information

Medicaid Managed Care Delivers Value and Efficiency to States

Medicaid Managed Care Delivers Value and Efficiency to States Medicaid Managed Care Delivers Value and Efficiency to States JUNE 2017 Contents Overview... 2 Factors that Influence State Medicaid Costs... 2 More Medicaid Beneficiaries Are Now Enrolled in MCOs than

More information

Improving Care for Dual Eligibles Opportunities for Medicare Managed Care Plans

Improving Care for Dual Eligibles Opportunities for Medicare Managed Care Plans Improving Care for Dual Eligibles Opportunities for Medicare Managed Care Plans Prepared by James M. Verdier Mathematica Policy Research for the World Congress Leadership Summit on Medicare Falls Church,

More information

Value based care: A system overhaul

Value based care: A system overhaul Value based care: A system overhaul Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu

More information

Flexible Accounting for Long Term Care Services: State Budgeting Practices that Increase Access to Home and Community Based Services

Flexible Accounting for Long Term Care Services: State Budgeting Practices that Increase Access to Home and Community Based Services Flexible Accounting for Long Term Care Services: State Budgeting Practices that Increase Access to Home and Community Based Services Recommendations for California By Leslie Hendrickson, Ph.D. Laurel Mildred,

More information

DECODING THE JIGSAW PUZZLE OF HEALTHCARE

DECODING THE JIGSAW PUZZLE OF HEALTHCARE DECODING THE JIGSAW PUZZLE OF HEALTHCARE HPCANYS Leadership Institute November 6, 2015 Carla R. Williams, MPA Director, O Connell & Aronowitz Healthcare Consulting Group WHAT IS GOING ON? ENVIRONMENT ACA

More information

Transforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept

Transforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept Transforming Louisiana s Long Term Care Supports and Services System Initial Program Concept August 30, 2013 Transforming Louisiana s Long Term Care Supports and Services System Our Vision Introduction

More information

Sunflower Health Plan

Sunflower Health Plan Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs Sunflower Health Plan Jennifer Windh September 2016 Long- term services and supports (LTSS) integration is the integration

More information

Alaska Mental Health Trust Authority. Medicaid

Alaska Mental Health Trust Authority. Medicaid Alaska Mental Health Trust Authority Medicaid November 20, 2014 Background Why focus on Medicaid? Trust result desired in working on Medicaid policy issues and in implementing several of our focus area

More information

State Innovations in Value-Based Care: ACOs and Beyond

State Innovations in Value-Based Care: ACOs and Beyond Advancing innovations in health care delivery for low-income Americans State Innovations in Value-Based Care: ACOs and Beyond Rachael Matulis, Senior Program Officer National Academy of Medicine Value

More information

State roles & responsibilities in Medicaid managed long-term care

State roles & responsibilities in Medicaid managed long-term care State roles & responsibilities in Medicaid managed long-term care Andrea Maresca Director of Federal Policy and Strategy April 24, 2012 Agenda Core State Managed Care Design Considerations Plan Payment

More information

The Changing Role of States in Long-Term Services and Supports

The Changing Role of States in Long-Term Services and Supports The Changing Role of States in Long-Term Services and Supports TennCare Overview Tennessee s Medicaid Agency Tennessee s Medicaid Program Managed care demonstration implemented in 1994 Operates under the

More information

programs and briefly describes North Carolina Medicaid s preliminary

programs and briefly describes North Carolina Medicaid s preliminary State Experiences with Managed Long-term Care in Medicaid* Brian Burwell Vice President, Chronic Care and Disability Medstat Abstract: Across the country, state Medicaid programs are expressing renewed

More information

State Policy Update. Liz Parry and Linda Shaw

State Policy Update. Liz Parry and Linda Shaw State Policy Update Liz Parry and Linda Shaw Overview Context of PACE and State Policy Role of State PACE Associations NPA s State Policy Priorities for PACE Growth of PACE PACE Sustainability Oversight

More information

Dual eligible beneficiaries and care coordination. Mark E. Miller, Ph. D.

Dual eligible beneficiaries and care coordination. Mark E. Miller, Ph. D. Dual eligible beneficiaries and care coordination Mark E. Miller, Ph. D. Medicare Payment Advisory Commission Independent, nonpartisan Advise the Congress on Medicare issues Principles Ensure beneficiary

More information

Diamond State Health Plan Plus

Diamond State Health Plan Plus I N T E G R A T E D L O N G T E R M Diamond State Health Plan Plus DSHP-Plus C A R E 1115 Demonstration Waiver Diamond State Health Plan (DSHP) Managed Care Delivery System Operational since January 1996

More information

States Roles in Rebalancing Long-Term Care: Findings from the Aging Strategic Alignment Project

States Roles in Rebalancing Long-Term Care: Findings from the Aging Strategic Alignment Project States Roles in Rebalancing Long-Term Care: Findings from the Aging Strategic Alignment Project Linda S. Noelker, PhD Katz Policy Institute Benjamin Rose Institute on Aging 11900 Fairhill Road, Suite 300

More information

COMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program

COMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program COMMONWEALTH COORDINATED CARE PLUS A Managed Long Term Services and Supports Program Agenda Background and Key Facts Populations Services Regional Launch CCC Plus Enrollment 2 Overview of Commonwealth

More information

Tennessee Health Care Innovation Initiative

Tennessee Health Care Innovation Initiative Tennessee Health Care Innovation Initiative More information available at: http://www.tn.gov/hcfa/strategic.shtml State Innovation Model grant 2 1 State Innovation Model (SIM) funding Last week the Centers

More information

COMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN. Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013

COMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN. Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013 COMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN I. INTRODUCTION Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013 In 1981, with the creation of the Community Options Program, the state

More information

The Next Wave in Balancing Long- Term Care Services and Supports:

The Next Wave in Balancing Long- Term Care Services and Supports: The Next Wave in Balancing Long- Term Care Services and Supports: Top Trends Agency restructuring is common States use of variety of resources to fund the programs Loss of historical knowledge is nationwide

More information

t-:-=:=.=contactd~:i~~~j ~~:~~ ~~~~~Care ====== =-=:=== --. :_=:=:== =-===: :j

t-:-=:=.=contactd~:i~~~j ~~:~~ ~~~~~Care ====== =-=:=== --. :_=:=:== =-===: :j Department of State Division of Publications 312 Rosa L. Parks, 8th Floor SnodgrassffN Tower Nashville, TN 37243 Phone: 615-7 41-2650 Email: publications. information@tn.gov For Department of State Use

More information

Improving Care for Dual Eligibles through Health IT

Improving Care for Dual Eligibles through Health IT Los Angeles, October 31, 2012 Presentation Improving Care for Dual Eligibles through Health IT The National Dual Eligibles Summit Duals Market is sizable Medicare and Medicaid Populations Medicaid Total

More information

Draft Children s Managed Care Transition MCO Requirements

Draft Children s Managed Care Transition MCO Requirements Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children

More information

Understanding Medicaid: A Primer for State Legislators

Understanding Medicaid: A Primer for State Legislators Understanding Medicaid: A Primer for State Legislators Introduction This booklet summarizes key elements of the Medicaid program, including basic answers to questions about the design and cost of the

More information

Medicaid Innovation Accelerator Project

Medicaid Innovation Accelerator Project Medicaid Innovation Accelerator Project 2016-2017 Technical Expert Panel In-Person Meeting Community Integration Community-Based Long-Term Services and Supports Breakout Session April 18-19, 2017 Community

More information

National Perspective No Wrong Door System. Administration for Community Living Center for Medicare and Medicaid Veterans Health Administration

National Perspective No Wrong Door System. Administration for Community Living Center for Medicare and Medicaid Veterans Health Administration National Perspective No Wrong Door System Administration for Community Living Center for Medicare and Medicaid Veterans Health Administration Agenda National Perspective No Wrong Door System What is a

More information

Assuring Better Child Health and Development Initiative (ABCD)

Assuring Better Child Health and Development Initiative (ABCD) Assuring Better Child Health and Development Initiative (ABCD) Presented by Jennifer May National Academy for State Health Policy Act Early Region X Summit Feb 4-5, 2010 Seattle, Washingon Supported by

More information

The Legacy of Sidney Katz: Setting the Stage for Systematic Research in Long Term Care. Vincent Mor, Ph.D. Brown University

The Legacy of Sidney Katz: Setting the Stage for Systematic Research in Long Term Care. Vincent Mor, Ph.D. Brown University The Legacy of Sidney Katz: Setting the Stage for Systematic Research in Long Term Care Vincent Mor, Ph.D. Brown University A Half Century of Ideas Most Scientists don t have a single field changing idea

More information

LTSS INNOVATIONS IN THE CURRENT ENVIRONMENT

LTSS INNOVATIONS IN THE CURRENT ENVIRONMENT NASDDDS National Association of State Directors of Developmental Disabilities Services LTSS INNOVATIONS IN THE CURRENT ENVIRONMENT March 8, 2018 INTRODUCTIONS Barbara Selter Sharon Lewis Camille Dobson

More information

Improving Care and Lowering Costs for Dual Eligible Beneficiaries

Improving Care and Lowering Costs for Dual Eligible Beneficiaries Improving Care and Lowering Costs for Dual Eligible Beneficiaries An Overview of Federal and State Efforts on Duals and Suggested Strategies to Position PACE National PACE Association September 13, 2011

More information

Medicaid Innovation Accelerator Program (IAP)

Medicaid Innovation Accelerator Program (IAP) Medicaid Innovation Accelerator Program (IAP) HCBS Conference IAP Session: Where We ve Been and Where We re Going September 2, 2015 Karen LLanos, David Shillcutt, & Michael Smith Center for Medicaid and

More information

Health Plans and LTSS. NASUAD April 20,2011 Mary Kennedy, ACAP Medicare Vice President 1

Health Plans and LTSS. NASUAD April 20,2011 Mary Kennedy, ACAP Medicare Vice President 1 Health Plans and LTSS NASUAD April 20,2011 Mary Kennedy, ACAP Medicare Vice President 1 Agenda ACAP Background Health Plan Interest in LTSS Developing Plan Capacity Relationship Building What should states

More information

Report to Congressional Defense Committees

Report to Congressional Defense Committees Report to Congressional Defense Committees The Department of Defense Comprehensive Autism Care Demonstration December 2016 Quarterly Report to Congress In Response to: Senate Report 114-255, page 205,

More information

North Carolina Medicaid Reform

North Carolina Medicaid Reform North Carolina Medicaid Reform Sandy Terrell Director, Clinical Policy Health and Human Services NC Health Care History c.1952 Good Health Act 1965 Medicare & Medicaid c.1972 Office of Rural Health 1877

More information

Developmental screening, referral and linkage to services: Lessons from ABCD

Developmental screening, referral and linkage to services: Lessons from ABCD Developmental screening, referral and linkage to services: Lessons from ABCD J I L L R O S E N T H A L S E N I O R P R O G R A M D I R E C T O R N A T I O N A L A C A D E M Y F O R S T A T E H E A L T

More information

MANAGING CHANGE PART II: SERVICE DELIVERY TRENDS

MANAGING CHANGE PART II: SERVICE DELIVERY TRENDS STRENGTHENING THE AGING NETWORK Building Leadership in the Long-Term Services and Supports Network MANAGING CHANGE PART II: SERVICE DELIVERY TRENDS Thursday, April 14, 2011 3:00 4:00 PM EDT Funded by 1

More information

Medicaid Managed LTSS: Great Opportunities, Big Risks

Medicaid Managed LTSS: Great Opportunities, Big Risks Medicaid Managed LTSS: Great Opportunities, Big Risks National Health Policy Forum May 11, 2012 Gordon Bonnyman Tennessee Justice Center gbonnyman@tnjustice.org 1 The Tennessee Context Tennessee has mandatorily

More information

Medicaid Home- and Community-Based Waiver Programs

Medicaid Home- and Community-Based Waiver Programs INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: October 2016 Medicaid Home-

More information

presentation will provide an overview of the history and purpose of PASRR

presentation will provide an overview of the history and purpose of PASRR Welcome to Ascend s PASRR training for Iowa PASRR Providers. The information in this presentation will provide an overview of the history and purpose of PASRR 1 Ascend, A MAXIMUS Company is an internationally

More information

Use of Medicaid MCO Capitation by State Projections for 2016

Use of Medicaid MCO Capitation by State Projections for 2016 Use of Medicaid MCO Capitation by State Projections for 5 Slide Series September, 2015 Summary of Findings This edition projects Medicaid spending in each state and the percentage of spending paid via

More information

Implementing Medicaid Behavioral Health Reform in New York

Implementing Medicaid Behavioral Health Reform in New York Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York HIV Health and Human Services Planning Council of New York March 19, 2014 Agenda Goals Timeline BH Benefit

More information

Friday Morning Collaborative Webinar

Friday Morning Collaborative Webinar Friday Morning Collaborative Webinar Community First Choice Option: State Consideration and Implementation Friday May 16, 2014 A non-profit service and advocacy organization 2011 National Council on Aging

More information

A Snapshot of the Connecticut LTSS Rebalancing Agenda

A Snapshot of the Connecticut LTSS Rebalancing Agenda A Snapshot of the Connecticut LTSS Rebalancing Agenda Agenda Medicaid context and vision State Rebalancing Plan Major elements of rebalancing agenda Money Follows the Person, Nursing Home Rightsizing,

More information

MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN

MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Louisiana Behavioral Health Partnership MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Rosanne Mahaney - Delaware Lou Ann Owen - Louisiana Brenda Jackson,

More information

FORGING SUCCESSFUL PARTNERSHIPS BETWEEN HEALTH PLANS AND STATES

FORGING SUCCESSFUL PARTNERSHIPS BETWEEN HEALTH PLANS AND STATES FORGING SUCCESSFUL PARTNERSHIPS BETWEEN HEALTH PLANS AND STATES James M. Verdier Second Annual Conference on Reaching, Retaining, and Serving Low Income Beneficiaries Las Vegas, NV July 24, 2007 Introduction

More information

Medicaid Transformation

Medicaid Transformation Medicaid Transformation Debra Farrington Senior Program Manager August 18, 2017 Medicaid Managed Care Already Exists in NC What North Carolina Has Now PRIMARY CARE CASE MANAGEMENT (CCNC) Primary care provider-based

More information

California s Coordinated Care Initiative

California s Coordinated Care Initiative California s Coordinated Care Initiative Sarah Arnquist Harbage Consulting Presentation on 4/22/13 2 Overview Federal and State Movement toward Coordinated Care Update on California s Coordinated Care

More information

2016 Staff Stability Survey Report

2016 Staff Stability Survey Report 2016 Staff Stability Survey Report January 2018 A COLLABORATION OF The National Association of State Directors of Developmental Disabilities Services and Human Services Research Institute www.nationalcoreindicators.org

More information

Driving Change with the Health Care Spending Benchmark

Driving Change with the Health Care Spending Benchmark Driving Change with the Health Care Spending Benchmark Delaware s Road to Value Kara Odom Walker, MD, MPH, MSHS Cabinet Secretary LIFE Conference, January 24, 2018 1 Join us on Twitter: @Delaware_DHSS

More information

Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care

Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care 1 2 Total Medicaid and CHIP population- 235,000 Currently approximately

More information

Introduction to UnitedHealthcare Community Plan of Iowa:

Introduction to UnitedHealthcare Community Plan of Iowa: Introduction to UnitedHealthcare Community Plan of Iowa: Provider Education Long Term Services and Support (LTSS) Agenda: Who we are How we can help Resources and support 2 Who We Are 3 Overview of UnitedHealthcare

More information

Virginia s Settlement Agreement with the U.S. Department of Justice (DOJ) and Proposed Plan to Implement the Terms of the Agreement

Virginia s Settlement Agreement with the U.S. Department of Justice (DOJ) and Proposed Plan to Implement the Terms of the Agreement FACT SHEET Virginia s Settlement Agreement with the U.S. Department of Justice (DOJ) and Proposed Plan to Implement the Terms of the Agreement Contents Overview Target Population Addition of Waiver Slots

More information

Medicaid and the. Bus Pass Problem

Medicaid and the. Bus Pass Problem Medicaid and the Bus Pass Problem PRESENTED BY: Cardinal Innovations Healthcare Richard F. Topping, Chief Executive Officer Leesa Bain, Vice President, Care Coordination & Quality Management September

More information

VIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE 12/2/2016

VIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE 12/2/2016 VIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE The Honorable Dr. William Hazel Secretary of Health and Human Resources Commonwealth of Virginia Why Is It Important to Integrate Medicare and Medicaid

More information

MLTSS PROGRAMS: SHARING DESIGN AND IMPLEMENTATION EXPERIENCES AUGUST 29, 2017

MLTSS PROGRAMS: SHARING DESIGN AND IMPLEMENTATION EXPERIENCES AUGUST 29, 2017 MLTSS PROGRAMS: SHARING DESIGN AND IMPLEMENTATION EXPERIENCES AUGUST 29, 2017 Deidra B. Abbott, MPH Kim Donica, Principal Bob Karsten, ASA, MAAA Mercer Angela Medrano New Mexico Human Services Department

More information

1115 Waiver Renewal Tribal Consultation June 23, New Mexico Human Services Department

1115 Waiver Renewal Tribal Consultation June 23, New Mexico Human Services Department 1115 Waiver Renewal Tribal Consultation June 23, 2017 New Mexico Human Services Department 1 Centennial Care 2.0 Concepts Public Comments Wrap Up Provide information about Centennial Care: overview, goals,

More information

CONNECTICUT: ECONOMIC FUTURE WITH EDUCATIONAL REFORM

CONNECTICUT: ECONOMIC FUTURE WITH EDUCATIONAL REFORM CONNECTICUT: ECONOMIC FUTURE WITH EDUCATIONAL REFORM This file contains detailed projections and information from the article: Eric A. Hanushek, Jens Ruhose, and Ludger Woessmann, It pays to improve school

More information

New Delivery Systems for Long Term Services and Supports: How States are Diving into Affordable Care Act Opportunities

New Delivery Systems for Long Term Services and Supports: How States are Diving into Affordable Care Act Opportunities New Delivery Systems for Long Term Services and Supports: How States are Diving into Affordable Care Act Opportunities September 2013 Sarah Barth, JD, Director of Coverage and Access Michelle Herman Soper,

More information

Transforming Payment for a Healthier Ohio

Transforming Payment for a Healthier Ohio Transforming Payment for a Healthier Ohio Greg Moody, Director Governor s Office of Health Transformation Legislative Joint Medicaid Oversight Committee August 20, 2014 www.healthtransformation.ohio.gov

More information

National Council on Disability

National Council on Disability An independent federal agency making recommendations to the President and Congress to enhance the quality of life for all Americans with disabilities and their families. Analysis and Recommendations for

More information

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint

More information

Healthcare Service Delivery and Purchasing Reform in Connecticut

Healthcare Service Delivery and Purchasing Reform in Connecticut Healthcare Service Delivery and Purchasing Reform in Connecticut Presentation to National Association of Medicaid Directors November 9, 2011 Mark Schaefer Director, Medical Care Administration Health Purchasing

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

FIDA. Care Management for ALL

FIDA. Care Management for ALL Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative

More information

AETNA MEDICAID. Respondent Demonstration to the Oklahoma Health Care Authority Care Coordination for the Aged, Blind, and Disabled.

AETNA MEDICAID. Respondent Demonstration to the Oklahoma Health Care Authority Care Coordination for the Aged, Blind, and Disabled. AETNA MEDICAID Respondent Demonstration to the Oklahoma Health Care Authority Care Coordination for the Aged, Blind, and Disabled August 26, 2015 Copyright Administrators, LLC 2015 Presenters Pam Sedmak

More information

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed

More information

RE: Centers for Medicare & Medicaid Services: Innovation Center New Direction Request for Information (RFI)

RE: Centers for Medicare & Medicaid Services: Innovation Center New Direction Request for Information (RFI) November 20, 2017 Ms. Seema Verma Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Ms. Amy Bassano Director Center

More information

Medicaid Home and Community Based Services Waivers

Medicaid Home and Community Based Services Waivers Medicaid Home and Community Based Services Waivers AN INTRODUCTION TO THE WORLD OF MEDICAID HOME AND COMMUNITY- BASED SERVICES AS OF MAY, 2017*** ***subject to change NASDDDS National Association of State

More information

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees TECHNICAL ASSISTANCE BRIEF J UNE 2 0 1 2 Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees I ndividuals eligible for both Medicare and Medicaid (Medicare-Medicaid

More information

Quality in Long Term Services and Supports (QuILTSS) for Nursing Facilities

Quality in Long Term Services and Supports (QuILTSS) for Nursing Facilities TENNESSEE LTSS VBP INITIATIVES NASHP Annual Conference 2017 10/24/2017 Quality in Long Term Services and Supports (QuILTSS) for Nursing Facilities Began in 2013 with stakeholder engagement. Bridge Payment

More information

The New NJ FamilyCare

The New NJ FamilyCare The New NJ FamilyCare 1 October 1, 2013 Changes 2 Newly eligible populations: Parents and Caretaker Relatives up to 133% FPL Single Adults and Couples without dependent children aged 19 64 up to 133% FPL

More information

Aetna Medicaid. Special Needs Plans. What Works; What Doesn t

Aetna Medicaid. Special Needs Plans. What Works; What Doesn t Aetna Medicaid Special Needs Plans. What Works; What Doesn t Topics Aetna Medicaid Overview Special Needs Plan (SNP) Overview Mercy Care experience as Medicare Advantage Dual SNP and ALTCS Medicaid MCO

More information

FIELD BY FIELD INSTRUCTIONS

FIELD BY FIELD INSTRUCTIONS TRANSPORTATION EMEDNY 000201 CLAIM FORM INSTRUCTIONS The following guide gives instructions for proper claim form completion when submitting claims for Transportation Services using the emedny 000201 claim

More information

Role of State Legislators

Role of State Legislators Title text here NCSL Fall Forum Preconference Session: Quality & Consumer Issues in Medicaid Managed LTSS December 3, 2013 Wendy Fox-Grage Senior Strategic Policy Advisor AARP Public Policy Institute Role

More information

Your Medicaid Matters: Serious Threats from Capitol Hill

Your Medicaid Matters: Serious Threats from Capitol Hill Your Medicaid Matters: Serious Threats from Capitol Hill Presented by Joseph C. Isaacs, MSPH, FASAE, CAE Vice President, Public Policy United Spinal Association January 26,2012 Your Medicaid Matters: Serious

More information

Innovations in Medicaid Managed Long-Term Services and Supports: How Health Plans are Providing Support to Family Caregivers

Innovations in Medicaid Managed Long-Term Services and Supports: How Health Plans are Providing Support to Family Caregivers Innovations in Medicaid Managed Long-Term Services and Supports: How Health Plans are Providing Support to Family Caregivers Wednesday, February 28, 2018 1-2 pm EST 1 Scorecard Emerging Innovations

More information

Moving To Value-Based Payment: What Are The New Models In Medicaid & Medicare?

Moving To Value-Based Payment: What Are The New Models In Medicaid & Medicare? Moving To Value-Based Payment: What Are The New Models In Medicaid & Medicare? #OMPerformance The 2017 OPEN MINDS Performance Management Institute Thursday, February 16, 2017 11:30am 12:45am Athena Mandros,

More information

Medicaid and You Yesterday and Tomorrow: How Medicaid and Payment Reforms Impact Assisted Living Providers

Medicaid and You Yesterday and Tomorrow: How Medicaid and Payment Reforms Impact Assisted Living Providers Medicaid and You Yesterday and Tomorrow: How Medicaid and Payment Reforms Impact Assisted Living Providers Ohio Assisted Living Association November 5, 2012 Suzanne J. Scrutton Vorys, Sater, Seymour and

More information

II. GENERAL INFORMATION ABOUT STATE HEALTH CARE REFORM INITIATIVES

II. GENERAL INFORMATION ABOUT STATE HEALTH CARE REFORM INITIATIVES II. GENERAL INFORMATION ABOUT STATE HEALTH CARE REFORM INITIATIVES State Health Care Reform Activity All 50 states, plus the District of Columbia, responded to the survey, with the vast majority of states

More information

Select Topics in Implementing an Integrated Medicaid Managed Long-Term Care Program

Select Topics in Implementing an Integrated Medicaid Managed Long-Term Care Program Select Topics in Implementing an Integrated Medicaid Managed Long-Term Care Program TennCare Overview Tennessee s Medicaid Agency Tennessee s Medicaid Program Managed care demonstration implemented in

More information

FEB DEPARTMENT OF HEALTH & HUMAN SERVICES

FEB DEPARTMENT OF HEALTH & HUMAN SERVICES DEPARTMENT OF HEALTH & HUMAN SERVICES FEB - 2 2016 Centers for Medicare & Medicaid Services Administrator Washington, DC 20201 Mr. Darin Gordon Director Bureau of Tenn Care Tennessee Department of Finance

More information