LTSS in Managed Care

A growing number of states are proposing to place the responsibility for providing long-term services and supports (LTSS) to seniors and people with disabilities under managed care organizations (MCOs). These proposals offer both significant risk, and considerable opportunity. Strong beneficiary protections specific to the delivery of LTSS must be incorporated to ensure that states and MCOs develop models that best supports independence and the ability of beneficiaries to remain in or return to community settings.

Details Matter! Advocates Library of Managed Long Term Services and SupportsContract Provisions allows advocates to research and compare contracts between states and managed care organizations. State contracts included with over 1,000 citations.

Advocates Recommend Ways to Measure Rebalancing In Managed LTSS and Dual Eligible Demonstrations (January 2014)

Florida Medicaid Long Term Care Guides and Tips
Seeking to prepare both advocates and consumers for Florida’s plan to move most consumers in long-term care to managed care, the Academy of Florida Elder Law Attorneys, Florida Legal Services and NSCLC have published a number of easy-to-understand materials. Choosing a Managed Care Plan | Consumer Tips for Enrolling in Long-Term Managed Care | Long-Term Services and Supports & Service Planning | Managed Long-Term Care Appeals and Hearings | Q & A for Advocates

Summary of CMS Guidance on Managed Long-Term Services and Supports (May 2013). The guidance consists of two documents, each of which sets forth 10 elements that CMS believes should be incorporated into managed LTSS (MTLSS) programs. This summary sets forth some noteworthy aspects of the 10 elements, and also briefly discusses the documents prepared by Truven Health Analytics.

Florida Advocates Call for Consumer Protections in Managed Care Contracts (April 2013). Florida Advocates recently submitted extensive comments to the state regarding the draft contract between the state and MCOs. Letter to Florida Medicaid Officials  |  CMS’s Duty to Review Contract Provisions  |  Cover Letter to CMS Officials  |  Draft Contract

Summary of Florida’s Long Term Care Managed Care Program, (March 2013). CMS approved Florida’s proposal to provide Medicaid long-term services and supports (LTSS) through managed care in February. This paper summarizes some important aspects of the Florida program.

A Review and Analysis of Recent CMS Waiver Approvals in New Jersey and New York, (March 2013). This paper provides a summary of how each new waiver addresses key elements of a MLTSS program and provides brief analysis of those approaches.

Identifying and Selecting Long-Term Services and Supports Outcome Measures, (January 2013). A new advocates’ guide prepared by the Disability Rights Education and Defense Fund (DREDF) and NSCLC. The guide focuses on outcome measures based on individual experience, as a beneficiary’s experiences are the best starting point for judging whether systems are performing well. The guide discusses existing and in-development quality measures, presents criteria for selection of LTSS outcome measures, suggests methods for building LTSS knowledge and infrastructure, and sets forth action steps for advocates.

Medicaid Long Term Services and Supports 101: Emerging Opportunities and Challenges, (September 2012). An advocates guide that offers advocates a primer on the law that impacts Medicaid-funded HCBS. It also explains the different programs states can use to provide HCBS, including those created by the ACA. The guide highlights key resources and tools to use when advocating to expand and preserve Medicaid coverage of crucial LTSS services in individual states.  In September 2012, NSCLC also offered a webinar on the topic.

Long Term Services and Supports: Beneficiary Protections in a Managed Care Environment. A toolkit for advocates on LTSS-specific beneficiary protections developed in partnership with the Disability Rights Education and Defense Fund (DREDF).

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