Anthony Fiori, director at Manatt, says he considers skilled-nursing care the “last frontier of risk.” It tends to be the last benefit that states bring into their Medicaid managed-care programs because it's usually the most difficult to manage. Lytle adds that it's also the most expensive form of care.
The AHCA's Cheek says there is concern in both the provider and beneficiary communities about the pace of implementing these Medicaid managed-care changes. Some states are planning to start managed-care programs for long-term services and supports next year, which he says is “concerning” given that states like Minnesota, Wisconsin and Massachusetts have been working with the managed-care plans for decades.
Cheek laid out the industry's concerns in dealing with health plans. He cautions that health plans might not understand the challenges in serving their vulnerable patient populations. For instance, Cheek says that determining the right length of stay for a long-term-care patient is quite different from setting a length of stay for a surgical patient. “Cost-control mechanisms don't really work with this population,” he says.
Next, there is the added administrative burden of dealing with each managed-care plan's requirements, which often necessitates hiring additional staff. There also are concerns about negotiating adequate rates. Some states, such as New York, require managed-care plans to use the state's fee-for-service rate for long-term services and supports for a limited period of time before they must begin negotiating rates with providers. But even then, Cheek says, the payment rate is frequently inadequate.
“We're already starting at a point of underpayment for fee-for-service,” he says.
For all of the challenges that post-acute care providers face in navigating the new managed-care world in Medicare and Medicaid, providers, advocates and policy analysts agree they don't have much choice.
“It's really important for all of our members to realize this is the new way of doing business,” says the AHCA's Michel. “To ignore it is to your own detriment.”
Follow Jessica Zigmond on Twitter: @MHjzigmond