Managed Care

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A Right to Person-Centered Care Planning

Person-centered planning encompasses the idea that the individual is at the heart of all decisions about services, supports, and care. This report analyzes how well states are implementing a 2014 rule that creates the right to person-centered care planning for Medicaid consumers of Long-Term Services and Supports. The report is a tool for health care providers, plan administrators, and advocates to help them understand the scope of the rules and be able to identify provision shortfalls.

Short URL: http://www.advancingstates.org/node/66400

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Building the Business Case: Community Organizations Responding to the Changing Healthcare Environment for Aging Populations

Healthcare providers, payers, and CBOs have historically operated as separate care delivery systems in which the responsibility for communicating and sharing information among providers has been on the client. A follow up to N3C's symposium at the 2014 ASA's Aging in America conference, this brief presents insights and actionable approaches that attempt to close the gap between fragmented and patient-centered care to evolve with the market and better provide for our communities.

Short URL: http://www.advancingstates.org/node/66195

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Fostering Person-Centered Supports and Services in Michigan's Nursing Homes

As part of PHI's One Vision: Moving Forward project, Michigan long-term care stakeholders discussed the potential use of Medicaid financial incentives to encourage person-centered care in nursing homes.The resulting publication outlines the ideas and recommendations produced by the discussion. The stakeholders primarily considered metrics, such as resident and staff satisfaction, that could be used to quantify nursing homes' commitment to person-centeredness.

Short URL: http://www.advancingstates.org/node/66158

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Medicaid: Additional Federal Action Needed to Further Improve Third-Party Liability Efforts

This GAO report examines (1) the extent to which Medicaid enrollees have private insurance, and (2) the state and CMS initiatives to improve third-party liability (TPL). Given the findings in the report, GAO recommends that CMS routinely monitor and share information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.

Short URL: http://www.advancingstates.org/node/66134

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Community-Based Organizations and MLTSS: An Issue Brief to Assess CBO Readiness

As almost half of the States have implemented MLTSS programs, community-based organizations, will be significantly impacted. At the 2013 HCBS conference, ADvancing States, with support from the SCAN Foundation, held a day-long intensive to discuss these impacts. This report outlines 5 discrete roles that CBOs are well-suited to play in MLTSS programs using as a reference point CMS’ 2013 guidance on MLTSS program design and implementation. To request a hard copy version, email Ali Diaz at adiaz@advancingstates.org.

Short URL: http://www.advancingstates.org/node/66027

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MLTSS Care Coordination and Ombudsman Case Studies

Community-based organizations will be notably impacted by States' implementation of MLTSS programs. Case studies on ombudsman programs and care/service coordination–culled from the MLTSS intensive at the 2013 HCBS Conference–complement the issue brief on CBO readiness. The ombudsman case studies highlight activities in Wisconsin, Hawaii, & Minnesota, while the care/service coordination case studies discuss CBO experiences in Massachusetts & Ohio. Both studies feature successful CBO practices.

Short URL: http://www.advancingstates.org/node/65962

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Measuring Up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care

The lack of recognized standards for what constitutes sufficient monitoring has hindered efforts to assess the effectiveness of state oversight of managed care plans. This brief describes an approach used to evaluate state oversight of a new Medicaid managed care program for individuals with disabilities in Washington. The approach evaluates both the type and vigor of monitoring activities by the state and the degree to which the state's activities achieved their desired program outcomes.

Short URL: http://www.advancingstates.org/node/65960

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Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011

This report developed new estimates of the program's effects for Program of All-Inclusive Care for the Elderly (PACE) enrollees in eight states based on more recent data. PACE plans provide coordinated acute and long-term care services to nursing home eligible seniors residing in the community.

Short URL: http://www.advancingstates.org/node/65901

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Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

Short URL: http://www.advancingstates.org/node/65894

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