After a long gestation, the federal government this week birthed new guidance designed to help managed care for Medicaid long-term services and supports (MLTSS) grow up into a more consumer-friendly, homey program. This is good news for the hundreds of thousands of people nationwide with mental and physical disabilities who depend on these services to help them live full lives.
Among the great new requirements are that states set up independent advocates or ombudsman for consumers in these programs, establish a state-level stakeholder advisory group and require managed care organizations to establish member advisory committees. In addition, states must provide independent counseling to consumers about their enrollment choices, and give them time to choose a managed care plan before they are automatically assigned. States must also use payment mechanisms that promote the home and community-based care that consumers prefer over nursing home care.
The guidance document from the Center for Medicaid & CHIP Services sets out 10 elements that federal regulators will use as they decide whether to approve new or revised LTSS programs in the states. The recommendations apply to LTSS programs designed using waivers of federal rules, called 1115 or 1915(b) waivers.
The Center summarized the elements in a four-page document. The elements are: Adequate Planning, Stakeholder Engagement, Enhanced Provision of Home and Community Based Services, Alignment of Payment Structures and Goals, Support for Beneficiaries, Person-Centered Processes, Comprehensive Integrated Service Package, Qualified Providers, Participant Protections and Quality.
The guidance doesn’t go as far as we’d like in some areas – for example, the ombudsman isn’t required to collect examples of systemic problems and recommend improvements to MLTSS. Also, the guidance doesn’t set specific standards to prevent disruption of care to consumers whose current providers are not in their new managed care plan. And requirements for transparency of managed care records are limited.
But the guidance lays a foundation on which to build. Advocates can use it to press states to do better for the many people eligible for Medicaid who need help with daily activities, personal care, chores and other services. In addition, the Center says they are open to refining the guidance as they and states develop more experience with managed care for LTSS. We’ll take them at their word on that, and offer a more detailed analysis on how the guidance can be strengthened in the coming weeks and months.