Long-Term Care

1. Medicaid Long-Term Care Managed Care Division of Medicaid and Long-Term Care Department of Health and Human Services

2. What is Managed Care? • Managed Care is a health care delivery system used by Medicaid agencies to manage: • Cost • Use/Utilization • Quality • Medicaid requirements not required of managed care: • Comparability • Freedom of Choice • Any Willing Provider

3. What is Managed Care? cont. • Managed care has to cover the services in the Benefits package in the same amount, duration, and scope as Fee-For Service Medicaid • Can place appropriate limits on a service based on medical necessity or utilization control • What constitutes medical necessity cannot be more restrictive than what is used in the State Medicaid program

4. What are Long-Term Care Services? Nursing Facility Personal Assistance Service HCBS waiver services *aged *physical disabilities *traumatic brain injuries Home Health These are all examples

5. Why Manage LTC? *Nebraska manages physical and behavioral health services for many Medicaid recipients… Why should Nebraska manage long-term care services? Let’s look at some data

6. Nebraska Medicaid Annual Report, Division of Medicaid & Long-Term Care, December, 2012.

8. SFY2012 Medicaid Expenditures for Long-Term Care Services Nebraska Medicaid Annual Report, Division of Medicaid & Long-Term Care, September, 2012

10. We manage recipients who are generally healthy, and have much lower average monthly costs We need to manage recipients who are require more services/benefits… so they receive

11. RIGHT 3 • Right Service at the Right Time in the Right Amount

12. CMS Principles for LTC managed care • Adequate planning and transition strategies • Stakeholder engagement • Enhanced provision of HCBS • Alignment of payment structures with MLTSS programmatic goals

13. Support for beneficiaries • Person-centered processes • Comprehensive and integrated service package • Qualified providers • Participant protections • Quality

14. What has been done so far? • Gathered data about clients, services, eligibility categories. We are analyzing it and determining what else we need to review. • Posted a Request for Proposal (RFP) to procure an actuary to develop the managed care rates and rate methodology. • Began conversations with interested parties, like you!

15. Some Next Steps • Continue outreach with providers, advocates, clients, family members, other stakeholders to solicit input, hear concerns, answer questions. • Develop RFP to post early 2014 to procure the long-term care managed care company • Obtain federal approval for waivers and state plan as necessary

16. Now let’s hear from you