Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
July 29, 2015 12:00 AM

Advocates split with health plans, states over Medicaid long-term care rules

Virgil Dickson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    Patient advocates are praising a section of the CMS' proposed Medicaid managed-care rule related to long-term care. But health plans and states are sharply critical of provisions imposing new credentialing requirements on long-term care providers and allowing beneficiaries to opt out of managed care if their provider is not in a health plan's network.

    The CMS included in the proposed rules a provision requested by patient advocates that allows beneficiaries enrolled in managed long-term care services and supports to switch plans or switch to fee-for-service Medicaid if their provider is out of network. Health plans blasted that provision.

    “Simply allowing the individual to disenroll from the managed-care plan to fee-for-service will undermine the use of managed-care plans in the Medicaid program, and may cause adverse effects to the managed-care entity,” Aetna said in its public comments on the rule.

    “We believe that disenrollment is not the best first option for beneficiaries receiving” long-term services and supports, Medicaid Health Plans of America said in its comments. “Rather, we believe that plans should have the opportunity to engage in single case agreements with the relevant provider before disenrollment is considered the option for the beneficiary.”

    Medicaid is the largest payer for long-term nursing-home care, and the Congressional Budget Office has estimated that Medicaid annual spending on long-term care will increase from $60 billion currently to more than $100 billion in 2023.

    Traditionally, state Medicaid programs have paid long-term care providers on a fee-for-service basis even as they moved more nondisabled beneficiaries into managed care. But as of 2014, 26 states were using managed long-term care, up from eight in 2004, according to the CMS. The number of beneficiaries in managed long-term care has grown from 105,000 in 2004 to 389,000 in 2012.

    States hope having private Medicaid plans manage services for the expensive population of elderly and disabled beneficiaries receiving long-term care services will lead to cost savings and better coordination of care, including a shift from institutional settings to home- and community-based care.

    The proposed Medicaid managed care rule covers long-term services and supports, or LTSS. The rule defines LTSS, and lays out policies to protect beneficiaries and ensure access to care.

    The rule defines LTSS as services and supports provided to beneficiaries of all ages who have functional limitations and/or chronic illnesses, and that have the primary purpose of supporting the ability of the beneficiary to live or work in the setting of their choice. Those settings may include the person's home or an institutional setting.

    The definition was largely embraced by patient advocates, who generally support the goals of managed long-term care but are wary about the method and pace of moving disabled beneficiaries into managed-care plans and about plans' ability to serve these vulnerable, high-needs people.

    “We support CMS' proposed definition of LTSS … as one that emphasizes the person-centered goals of LTSS rather than list off specific services,” the Disability Rights Education and Defense Fund said its public comments on the proposed rule. “We believe the breadth of this approach is needed and best supports a potential evolution of managed-care delivery of LTSS in ways that will meet the actual and most urgent and vital needs of Medicaid enrollees with long-term needs.”

    Justice in Aging, an advocacy group for low-income seniors, was enthusiastic about proposed training for managed-care organizations and network providers on community-based services. “For care coordination to truly be effective, at a minimum, the care coordinators, case managers and (managed-care plan) staff leading the interdisciplinary team need a clear understanding of the community-based supports network,” the group said in its comments.

    But state Medicaid agencies expressed concern about a proposal requiring states to establish credentialing and recredentialing policies for individual and organizational providers participating in their managed-care programs, including those caring for Medicaid beneficiaries receiving LTSS services. Medicaid LTSS providers include personal attendants, peer counselors, outpatient treatment centers, residential treatment centers, and group homes.

    “There are no existing credentialing criteria that could be utilized to address entities and individuals that are not licensed by the state and may not be certified under current rules or requirements,” the Arizona Health Care Cost Containment System, the state's Medicaid agency, said in its comments. The rule “would impose a significant burden on the state and also serve as a disincentive for individuals to work in these types of positions, potentially creating access to care concerns,” Arizona's Medicaid agency says.

    The National Association of Medicaid Directors agreed. “It is operationally unfeasible for the CMS to require credentialing for all LTSS provided in Medicaid,” the group said in its comments. It noted that many in-home providers of LTSS services are family caregivers.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Rob Allen Intermountain 23
    Intermountain's Graphite Health may be AI 'grounding point,' CEO says
    Nursing home wheelchair
    4,000 Michigan nursing home beds at risk in proposed staffing mandate
    Most Popular
    1
    CMS tries luring providers to revamped Medicare ACOs
    2
    Oregon joins other states in setting ratios for nurse staffing
    3
    Blue Shield CA taps Amazon, Mark Cuban, CVS for new PBM model
    4
    A health innovation hub grows in Lake Nona Medical City
    5
    Hospital-at-home providers push for Medicaid coverage
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing