The decentralized nature of Home and Community-Based Services, and the fact that many HCBS providers travel to an individual’s home rather than service recipients traveling to provider facilities, have presented real difficulties for policymakers and advocates seeking to determine the most appropriate means of measuring network adequacy for LTSS providers. This report outlines multiple options that are available to state policymakers seeking to evaluate network adequacy for HCBS providers under MLTSS programs.
Reports & Publications
We reviewed managed long-term services and supports (LTSS) contracts for nine states in order to understand the extent to which they promote physical and programmatic accessibility for enrollees with disabilities. Medicare/Medicaid duals demonstration contracts for Virginia, Illinois, Massachusetts, Michigan, New York, and South Carolina contain provisions that represent a ground shift in federal expectations and requirements for physical and programmatic accessibility of managed care organizations (MCOs) and the providers with whom they contract.
As a growing number of states adopt Managed Long-Term Services and Supports frameworks, it becomes imperative that ongoing efforts to promote HCBS over institutional services continue and are integrated into the incentives and requirements of managed care contracts. Managed care can help states accelerate the shift towards the community--or slow and reverse it, depending on the incentives put into requests for proposals and contract language.
In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Post-enrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time. Results showed increased satisfaction with benefits, improved ratings of quality of care, fewer acute care visits, and increased personal care assistance hours over time.
Researchers at the University of California conducted an evaluation of the implementation and impact of the CMC program on health systems and beneficiaries. This research brief examines the implementation of the new CMC care coordination benefit, including the progress made and challenges that remain in coordinating care for dual eligibles. Results are summarized from 94 key informant interviews with health system stakeholders.