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

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

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 3

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

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

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

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

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

RIGHT Right Service at the Right Time in the Right Amount 3

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

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

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!

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

Now lets hear from you