UPDATE ON LOUISIANA’S MANAGED CARE AND LONG-TERM SUPPORTS
AND SERVICES INITIATIVE IN LOUISIANA
January 13, 2014
This update summarizes what occurred at the Medicaid Managed Care and Long-Term Supports and Services (MLTSS) Advisory Group meeting held on January 9, 2014. This document was prepared by Karen Scallan, member of the MLTSS Advisory Group representing parents of children and youth with developmental disabilities and complex needs. Questions regarding this information should be directed to Kcscallan@gmail.com.
HOW TO COMMENT ON MLTSS IN LOUISIANA
YOUR VOICE IS IMPORTANT. THESE CHANGES WILL CHANGE HOW YOU OR YOUR LOVED ONE RECEIVES WAIVER SERVICES. See the note at the end of this update regarding future meetings and public forums. In the meantime, learn more and send your comments by visiting the following links:
Find out More, Visit: http://new.dhh.louisiana.gov/index.cfm/page/1684/n/379
Send Comments to: dhh.louisiana.gov/index.cfm/page 1684/n/379.
OPTIONAL OPT IN FOR WAIVER RECIPIENTS TO BAYOU HEALTH
Regarding the feedback provided to DHH by some members of the MLTSS Advisory Group that an OPT IN to the Bayou Health program would be beneficial for some waiver recipients, an update was provided at the January MLTSS meeting. DHH announced that an Emergency Rule will be issued in the next few weeks on this issue.
For more information, see MLTSS Update, December 2013
MEETING SET UP
There were no presentations during opening remarks. The Advisory Group broke into 4 subgroups to address questions in their respective concept paper and to answer questions proposed in the Request for Proposal concept paper. These concept papers can be found by visiting http://new.dhh.louisiana.gov/index.cfm/page/1684/n/379 . The four work groups were:
- Benefit Design
- Care Coordination
- Enrollment
- Populations
After the subgroups met to discuss and answer the proposed questions, they returned to the larger group to present to the whole body and audience. This format will continue with upcoming meetings. I attended the Care Coordination workgroup.
The following is a summary of what each workgroup presented to the whole body and what we discussed in the Care Coordination group.
BENEFIT DESIGN SUB GROUP
Questions for the Benefit Design Group included: Should benefits be “all-inclusive,” i.e., include medical, pharmacy, behavioral care along with LTSS? What kind of LTSS should be included? Should all current LTSS Service be retained? What additional services should be included? How can the make sure the MCO can provide services beyond the state plan if cost effective and address the individual’s needs? What emphasis should be placed on evidence based/promising practices?
The group responded that
●Benefits should be fully integrated with no carve-outs to improve the access to services, quality. Care coordination with appropriate qualifications though is critical.
●All the current service array should be available, plus acute care, bayou health services
●Service definitions should remain relatively the same to ensure no loss of services during management cross-over to Managed care.
●Services that should be added include, Developmental Disabilities, Vision, Employment, Transportation, including non-medical transportation; hearing, OT, PT, Speech, adequate number of services to meet needs of the individuals in the community; assisted living; providers allowed to bill for team consultation; podiatry and specialty care; palliative care; increased use of technology for health and activity monitoring.
●The MCO should have flexibility to cover whatever is needed in order to reach the desired outcome. Examples were given from the PACE program where an individual was in danger of having to be removed from their home and placed in an institution due to pest infestation. PACE paid for extermination costs.
●Emphasis should be placed on evidence based and promising practices and should also encourage innovation.
Questions included:
Q: Was transition from ICF/DD, Nursing facilities discussed?
A: The concept paper said it was listed already as a service to they did not discuss it.
Q: What details were discussed regarding Innovation?
A: Innovation discussed was broader than just technological innovation. Innovation should be encouraged for types and methods of treatment. The organization should be looking for new practices that can be implemented.
Q: Regarding the current services, did anyone discuss tweaking or improving those?
A: No, that could be a further topic for discussion.
ENROLLMENT SUB GROUP
Questions for the Enrollment Group included: DHH’s position is that enrollment must be mandatory, what protections should be provided to help with enrollment? What ideas do you have for how to ensure continuity of services at initial enrollment? What circumstances might warrant a change in plans outside the enrollment period? Any additional marketing rules?
The group responded that
Protections should included
●Emphasis on unique and diverse populations served
●Assistance to correctly identify needs and match that with plans
●Ability to distinguish chronic and acute issues
●Policies in place for clear information about coverage
●Literacy levels
●Lack of family technology–in person assistance
●Significant enroller training
●Transportation supports
●Flexibility and accommodations due to changing needs
●One-stop assistance (not multiple steps)
●Options for enrollment counseling
The group encouraged thinking beyond a contract for enrollment entity. Suggested partners for enrollment assistance are LGE’s (Local Government Entities, i.e., Human Service Districts and Authorities), Advocacy Center, Councils on Aging, other advocacy groups if conflict free that have a capacity for enrollment counseling. Training was emphasized if the state seeks out training partners to ensure a consistency of message.
Ideas for continuity of services at enrollment included
●Readiness assessment by DHH and the plans
●30 day period grace to ensure no gaps in personal care assistance. Emphasis was
indicated that this was very important for OCDD and the clients.
●Mandatory enrollment for all providers
●Possibly requiring all providers to provide all services
●In changing plans outside enrollment period, the group felt that DHH could not adequately build a “for cause” list, especially if service array includes all services in an integrated service model. A for cause list would not simply be medical, but quality of life as well. They recommended the state make it very clear in the contract that the MCO would be providing a consistent array of services so if someone’s situation changes, there has to be a provider in the plan to meet their needs.
●Additional marketing rules recommended included no cold calls or push of clients should be allowed.
Questions included:
Q: Partners for enrollment may not all be on the same page
A: There must be an emphasis on training with expectations spelled out and the understanding that messages need to be consistent.
Q: Couldn’t some of the issues with requests to change plans during enrollment period be handled through grievance policies
A: Yes
Q: Bayou Health has been an issue; some plans weren’t able to meet needs
A: Inability to meet the needs would warrant a change
A: FROM DHH REP: The RFP must make sure they have key indicators there to meet the clients’ needs.
POPULATIONS SUB GROUP
Questions for the Populations Group included: Which populations should be included in the ID/DD Procurement? Which in the Adult Aging/Disability Procurement? Are there any groups getting LTSS that should be excluded? Do you agree to excluding PACE, QMBs and SLMBs? (QMBs/SLMBs are under Federal poverty guidelines and their co-payments for Medicare are paid by Medicaid). Should healthy people with Medicaid and Medicare dually be included (i.e., not receiving any LTSS)? What strategies would best serve people with ID/DD who get services through OAAS? Would PCA and Nursing Facility (NF) services in the ID/DD benefit package help address their needs? What strategies would be best for transitioning people from Bayou Health plans or Behavioral Health Partnership plans to MLTSS plans?
The group responded that
●All ID/DD populations should be included in the ID/DD procurement
●All Adult Aging/Disability populations should be included in the Aging Adult procurement.
●No groups should be excluded except for PACE, QMBs and SLMBs
●PACE enrollment should be directly from PACE in areas where PACE already exists.
●Healthy duals should be included (i.e., those not receiving LTSS), but the group did not management of their Medicare services in their recommendations).
●Strategies included a comprehensive plan design to keep people from going in and out of plans.
●PCA and NF services should be included in the ID/DD Benefit group.
●Group requested analysis of who in Bayou Health or Behavioral Health Partnership would be transitioning to MLTSS once implemented; and strategies should include education and training
●a Geographic and phased in enrollment was proposed.
CARE COORDINATION SUB GROUP
Questions for the Care Coordination Group included: Should Care Coordination (CC) responsibilities be fully integrated into the MCO? What are come CC improvements you hope to see in transformation to MLTSS? What conditions or circumstances should be addressed through specialized care coordination? How might the RFP best solicit info regarding CC Competency? Should MCOs be asked to describe their values and approach to CC? If so, What values/type of approach should the state be looking for? What competencies are important in providing care coordination to the disability population(s)?
The group responded that
●Questions arose regarding the first question. Clarification indicated that DHH wanted to know should there be a separate procurement for a care coordination contract.
●The group responded that CC should be fully integrated into the MCO, but,
●With significant safeguards to avoid denial of access to needed services and care
●CC in the MCO should be based on CMS guidelines and principles and definitely include
●A strong ombudsman contract to work out issues
●A strong grievance process to support the individual, and
●DHH oversight and ability to overrule a decision.
Improvements to CC should include
●If CC incorporates planning, CMS Guidelines should be used
●Oversight and review for the whole person, behaviorally, acute care, employment
●There should be someone/an entity looking out for the where community resources
are needed and what community resources are because physicians cannot know that
●Strong medical home/acute care management for individuals with DD/with co-
occurring complex medical needs
●One source for CC which is all inclusive of all services
●Right services out there (i.e., you can’t coordinate something that doesn’t exist)
●CC and providers should be able to view all the services a person is getting at one
portal
●Electronic health records with patient and provider portals and utilization.
●MCO should be required to participate in the State Health Information Exchange
●Better technology is needed overall (there must be a commitment to this in the RFP)
●A flexible system regarding who takes the lead on CC (family, physician, psychologist)
●Increased access to HCBs
●Increased access to meaningful employment even in challenging areas such as rural
communities
●person-centered processes
●CC capacity to make decisions that facilitate movement to the LRE
●Access to CC for people in institutional settings, regardless of whether they are
transitioning out of the institutional setting.
Specialized CC should be available for these circumstances
●A self-directed care coordination model allowing family members or other designees
to coordinate care
●Transition support services to facilitate movement between settings
●High risk populations with many critical incident reports that put community
placement at risk (suggestion that by x # of critical incidents, this may trigger a CC
review).
●Mental health when co-occurring with ID/DD
●Medically complex individuals
●Question was raised whether a PACE-like approach could be used for additional
population groups with safeguards against segregation.
●Specialized CC for employment and community integration needs
●Specialized for communication needs
●Homelessness
●Use of peer-parents, peer-youth and self-advocates on care coordination teams
What values /approach to CC should the MCO have?
●MCO’s should have to describe their values and approach to CC if CC is included in
their responsibilities.
●These values should be consistent with CMS Guidelines
●should be person centered
●should be people first
●people should be valued regardless of their label and individual’s ideas and prejudices
based on those labels should not be allowed.
Competencies included:
●Experience in all areas of service array they are providing to DD/ID populations
●Ability to describe how they will increase competencies necessary to meet values and
expectations
●Core components of assessment planning and monitoring
●see recommendations in AARP article on readiness reviews
●Cultural and linguistic competencies and not just race/ethnicity competencies.
●Community supports and methodology to acquire community resource information
●integration of formal and informal supports
●current groups that are working in the ID/DD arena
●ability to participate in the Health Information Exchange
●Addressing community gaps
●Involvement at the community level (ex. Affordable housing)
●Addiction and Mental health as co-occurring disorders
NEXT MEETINGS AND OPPORTUNITIES TO GIVE COMMENT
Next meeting
The next meeting is Thursday, February 6, 2014, 10:00 am. For the next meeting, there will be four work groups: (1) Rebalancing, (2) Providers, (3) Choosing Partners, and (4) Implementation.
Public Forums
Public forums will being in January. These will include regional stakeholder meetings arranged by the Department of Health and Hospitals (DHH), webinars, and additional events where Long Term Supports and Services transformation can be discussed. DHH is seeking information on other events where they can present. Public forum dates will be announced soon.
Subsequent Meeting Dates
Next meeting is June 2014
RFP Release anticipated in Summer 2014
For questions regarding this update contact:
Karen Scallan
kcscallan@gmail.com
Parent Perspectives on MLTSS 