Commonwealth of PA Managed Long-Term Services and Supports Discussion Document

Commonwealth of PA Concept Paper on Community Health Choices

6/9/2015 ABC’s of Managed Care

What is Managed Long-Term Services and Supports

Managed Long-Term Services and Supports Glossary of Terms (National Council on Disability)

David Gate’s Presentation PowerPoint

Q&A from ABC’s of Managed Care

7/14/2015 Person-Driven Services in Managed Long-Term Services and Supports

10/5/2015 Update on Managed Long-Term Services and Support

PowerPoint Update on MLTSS slides

PDSS Coalition Comments on MLTSS 2015

PDSS Coalition Comments on Community HealthChoices 2015

Person-Driven Services in Managed Long-Term Services and Supports

Benefits and Risks for Managed Long Term Services and Supports

Potential Benefits of Medicaid Managed Long-Term Services and Supports (LTSS)

  • Can shift services from institutional care to home and community based care
  • Can improve coordination of services, especially in states where MCOs provide acute and behavioral care and LTSS
  • Stabilize State Costs and make budgeting more predictable

Potential Risks of Medicaid Managed Long-Term Services and Supports

  • Loss of essential services that could lead to illness or institutionalization
  • Reduction of capitation rate paid to MCOs below the level needed to maintain adequate access to care
  • Move to “medical model” if administered by health insurers
  • MCOs reducing services or cutting payments to providers
  • May significantly reduce consumer choice of treatment locations and providers
  • MCOs may challenge consumer-directed services

Considerations for reducing risks:

  • Ensure real consumer and community stakeholder input in the system design and monitoring.
  • Ensure appropriate trainings and supports to enable use of person-directed options.
  • Ensure transparency of all contracts by making them public and require reporting on finances, reserves, provider rates and patient outcomes.
  • Explicit priority included in MCO contracts for least restrictive settings that incorporate payment methods and performance measures that incentivize community based care.
  • Include clear definitions and terms of any restrictive rules like services that are considered “necessary”.
  • Ensure a broad range of services is included in LTSS that include both traditional and non-traditional services like person-directed services, family support, home modifications, behavioral health support, peer support and recovery services without waiting lists or caps.
  • Ensure diverse, robust and adequate provider networks who are culturally and linguistically competent, accessible and trained in independent living and recovery models to ensure quality, choice and continuity of care.
  • Require MCOs to do person-directed models that maximize consumer control, choice and independence as opposed to the traditional agency or medical model
  • Ensure quality of care through care coordination both within LTSS and with other parts of the health system using community groups that are independent, conflict-free care coordinators experienced in working with seniors and people with disabilities that are not providers nor employees of the MCO.
  • Ensure performance measures specific to LTSS that does not jeopardize quality of care in pursuit of savings by linking payments to quality of service through incentives or penalties.
  • Require standardized conflict free assessments of LTSS plans with a focus on consumer goals.
  • Ensure Assessment of MCOs in ability and knowledgeable about needs and services of population utilizing LTSS

Different Groups’ Position Papers:

Disability Rights Network of PA

Pennsylvania Health Law Project

Pennsylvania Long Term Care Commission

The Arc of PA

National Advisory Board: Managed Care Doing it Right Toolkit