Managed Care in LTSS and Developmental Disability Services ... Arc MLTSS PRESENTATION FINAL.pdfNational Association of State Directors of Developmental Disability Services & HSRI Guidebook

2014 National Convention

network improve lead

Managed Care in LTSS and

Developmental Disability Services:

The Family Perspective Presented by:

Karen Scallan, CPSP

Special Needs & Parent Support Services of LA, LLC



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SNAPSS of LA, LLC

• Special Needs & Parent

Support Services of LA, LLC

• Certified in providing support

and advocacy services to

individuals and families of

individuals with disabilities.

• One of only 2 CPSPs in

Louisiana

• Assisting families in complex

health or benefit issues.

• System Change Advocacy.

• Statewide.

• Karen Scallan, CPSP

• Special Needs & Parent Support

Services of LA, LLC

• Certified Parent Support Provider

• Phone: 504-430-3604

• Email: [email protected]

• Twitter: @KarenScallan

• Facebook: Karen Scallan

• Blog:

http://parentperspectivesonmltss

.wordpress.com



Objectives

• Provide an understanding of what managed

long-term supports and services (MLTSS)

means.

• Provide an understanding of the opportunities

for advocacy around MLTSS for individuals and

their families.

• Provide a better understanding of the parent

perspective around MLTSS.

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What is LTSS/MLTSS?

• LTSS is Long-Term Supports and Services. It includes nursing home services, home and community based services, institutional care.

• MLTSS is Managed Long-Term Supports and Services applying managed care techniques to LTSS.

• MLTSS umbrella could include other services though!



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Why Manage LTSS? • Cost savings (?)

• Cost predictability for states.

• Improved outcomes (?)

• Meeting increased demand (?)

In LA developmental disability waiver services are lean. Cost savings will come from institutional care (nursing facilities, ICF/DDs) and un-managed medical care.

ICF/DD= Intermediate Care Facility for Individuals with Developmental Disabilities



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• Louisiana issues Request for Information • La Department of Health & Hospitals

(DHH) invited potential MCOs to present.

• DHH started the MLTSS Advisory Group.

• MLTSS Advisory Group met several times and continues to meet.

• Office for Citizens with Developmental Disabilities (OCDD) is making changes to correct current problems in the system before MLTSS is implemented. (System Transformation Workgroup including families).

Louisiana’s Process

MCOs= Managed Care Organizations



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Louisiana’s Process

• Meetings of MLTSS Advisory Group tackled (via sub groups) – Choosing our Partners

– Focusing on Providers

– Rebalancing

– Implementation

– Benefit Design

– Care Coordination

– Enrollment

– Populations

– Accountability

– Consumer Protections

– Measuring Quality and Outcomes

– RFP Development and Procurement

– Stakeholder Engagement and Communication



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Concerns for Families: Managed Care for

Developmental Disability Services

• MCOs are predominantly experienced in

managing medical care;

• Most MCO experience in MLTSS is with

individuals who are elderly;

• MCOs have little to no experience with

individuals with intellectual or

developmental disabilities (I/DD).



• Louisiana will address this by a

using a 2-Phase approach to build

capacity, knowledge, and abilities

of the MCO to work with

Individuals with intellectual and

developmental disabilities.

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• MCOs will have to address quality of life measures, not just quality of health care.

• MCOs must address Employment services for waiver recipients.

• MCOs must preserve of self-determination of individuals and self-direction programs.





• Louisiana will include performance

improvement projects in the MLTSS

contract one of which will be an

employment initiative

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• Reduction of providers available after “any willing provider” clause expires.

National Association of State Directors of Developmental

Disability Services & HSRI Guidebook on Managed care and

Developmental Disabilities regarding a 1996 program of

managed care for elderly individuals in Minnesota.

“…the task for long-term care providers will be to position themselves

to offer services which can substitute for acute care services and/or

provide the expertise and resources needed to meet the needs of

MCOs as they expand the services covered in their capitations in

response to purchasers such as state and federal governments or

retirement plans."





• Louisiana will

– Include an LTSS “Any willing provider”

clause for Yr 1;

– Set rates year 1;

– Set rate floors.

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• New managed care practice

of “Network Narrowing”

• Not all because they did not

met health outcomes

• Physicians on high end of the “usual and customary scale” were dropped, despite high outcomes for patients

• What does Network Narrowing mean to those with complex health care needs…

Just because there is a

urologist in the network does

not mean that urologist

understands complex urologic

problems associated with

individuals with Spina Bifida.





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• Care coordination of significantly

medically involved individuals and

individuals with dual-diagnoses.

• Will care coordination = reduction of

services, denials of care?





• Louisiana will

– Include a flexible care coordination

team with an experienced I/DD care

coordinator for LTSS with a secondary

care coordination for acute care and

behavioral health.

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INCLUDING EARLY INTERVENTION in MLTSS:

• Educational model, not medical

• Services provided in natural settings, not clinical

• Funding from US Department of Education

• Congressional intent: to reduce costs to school districts

• Required education components of pre-literacy, school readiness, language, and numeracy.



• Louisiana will

– Include all early intervention services

in MLTSS

– But not in a capitation rate system

– Included administratively (i.e.,

handling paperwork, but not

managing care

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• Elimination of Waiver Waiting lists Discussion MUST include BOTH increase in

funding for HCBS AND RETENTION OF CURRENT

ELIGIBILITY REQUIREMENTS

• Independent Consumer Education

and Meaningful Information Medical limits and other details of plans

• TRUE Person-Centered planning





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• Language Concerns

– Multiple Language Translation

of ALL materials

– Multiple Translations on web

sites

– Meaningful web sites

– Audio files reading info on

websites





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• What assessment will be used to determine level of need? Who will conduct the assessment? – LA uses SIS/LA Plus--Probably

won’t be used for long.

– Costing more and more each year

– Push for state-required assessment

– No arbitrary or varying MCO assessments





• Louisiana will

– Develop a life-span assessment

– Which will be administered by a third

party, non-risk by the MCO

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• Expansion of provider network for current services with inadequate networks.

• Exemptions to requirements for in network providers when continuity of care is essential.

• Care in the least restrictive environment a top priority while preserving choice and self-determination.





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LA’s MLTSS Advisory Group

Recommendations

• MCOs and State invest in quality

monitoring staff.

• Ombudsman Program in addition to an

External Quality Review contract (EQR)*

• Independent surveys of quality

• Individuals with disabilities and Family

Members as components of MCO advisory

panel and on care coordination teams

• All payments to MCOs tied to quality

measures.



• Louisiana will

– Include an independent Ombudsman

contract in the MLTSS program

– Provide for independent surveys of

quality by OCDD or an independent

contractor

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LA’s MLTSS Advisory Group

Recommendations



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Ombudsman v. EQRO

Ombudsman

• Independent Contract

• vital to solving urgent issues

• In-the-moment

• Data collection

• Anecdotal stories supporting data

• Can drive system change and advocacy initiatives

EQRO

• External Quality Review

(EQR)

• Required by Medicaid

• Main purpose to conduct “analysis and evaluation of

aggregated info on quality

timelines, and access to

health care services that an

MCO or PHP or their

contractors furnish to

Medicaid recipients.”



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Recommendations by Louisiana’s

MLTSS Advisory Group

• Readiness Assessment – MCO network adequacy

– the state’s ability to support the MCO and providers,

– provider adequacy to meet technology and other requirements.

● Flexible Care Coordination allowing for different care coordination leader, (family, physician, psychologist) and innovation should be sought out for a self-directed care coordination model.



• Louisiana will include a

comprehensive readiness

assessment of all systems in MLTSS

• Care coordination….not sure yet

what it will exactly look like.

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Recommendations by Louisiana’s

MLTSS Advisory Group



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A lot to take in…



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The Devil Will Be in the

Details.



MLTSS and Louisiana

Parent Perspective on MLTSS:

http://parentperspectivesonmltss.wordpress.com

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Questions?

Documents

Managed Care in LTSS and Developmental Disability Services ... Arc MLTSS PRESENTATION FINAL.pdfNational Association of State Directors of Developmental Disability Services & HSRI Guidebook