Arizona Health Care Cost Containment System. (October 2012). Quality Assessment and Performance Improvement Strategy. http://www.azahcccs.gov/reporting/Downloads/QualityStrategy.pdf. Accessed September 4, 2013.
This report summarizes AHCCCS (the single State Medicaid Agency) quality improvement strategy, including history of the program, the process for overall quality strategy development, the objectives of the strategy, how quality and appropriateness of care are assessed, improvement interventions undertaken, and the strategy's effectiveness.
Center for Health Systems Research and Analysis, University of Wisconsin-Madison. (2012). PEONIES Member Interviews: Final Report. http://www.chsra.wisc.edu/peonies/documents/PEONIES%20Final%20Report%20SFY2012%20-%20rev%2011-9-2012.pdf. Accessed June 21, 2013.
This report summarizes the purpose, methodology, and findings of the PEONIES survey developed by the Wisconsin's Department of Health Services.
Centers for Medicare and Medicaid Services. (2013). Guidance to States using 1115 Waiver Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf. Accessed August 30, 2013.
This document provides states with guidance on the elements CMS considers essential for any Medicaid MLTSS programs, both those that currently exist as well as those under development.
Centers for Medicare and Medicaid Services. Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid (Medicaid Adult Core Set). http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-Adult-Core-Set-Manual.pdf. Accessed September 26, 2013.
The report presents a core set of health care quality measures for use by states to assess health care quality delivered to the adult Medicaid population.
Centers for Medicare and Medicaid Services. (June 27, 2013). Planning and Demonstration Grant for Testing Experience and Function Tools in Community-Based Long Term Services and Supports (TEFT). Publication No.CMS-1H1-13-001. http://www.grants.gov/web/grants/view-opportunity.html?oppId=195253. Accessed September 26, 2013.
This RFP is a call for states to apply for TEFT grants to support state use of a cross-disability experience of care survey and a setting/population-agnostic assessment tool for use in Medicaid HCBS programs. It also supports states in the development and use of e-LTSS records and HCBS Personal Health Records.
Dembner, A. (November 2012). Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports. Community Catalyst, Inc. http://www.communitycatalyst.org/doc_store/publications/putting_consumers_first_LTSSmanagedcare.pdf. Accessed May 13, 2013.
This paper discusses the benefits and risks of Medicaid MLTSS for the consumer. It addresses strategies for minimizing risks and maximizing consumer benefits, from program development through operation and monitoring phases.
Family Care. An Overview of Wisconsin's Family Care Program. http://www.dhs.wisconsin.gov/ltcare/pdf/FCoverview.pdf. Accessed June 21, 2013.
This paper is an overview of Wisconsin's Family Care Program, including program history and operation.
Galantowicz, S. (June 2010). Environmental Scan of Measures for Medicaid Title XIX Home and Community Based Services: Final Report. Agency for Healthcare Research and Quality, AHRQ Publication No. 10-0042-EF. http://www.ahrq.gov/research/ltc/hcbsreport. Accessed 6-26-2013.
This paper is an environmental scan of measures used in Medicaid HCBS programs and includes measures that address functioning, satisfaction, and program performance.
General Accountability Office. (May 23, 2008). Medicaid Home and Community-Based Waivers: CMS Should Encourage States to Conduct Mortality Reviews for Individuals with Developmental Disabilities. Publication No. GAO-08-529.
This GAO report examined 14 states' approach to mortality review for Medicaid HCBS waiver programs serving people with developmental disabilities. The report includes the key components of what should constitute a mortality review process. The GAO recommended that CMS encourage states to conduct mortality reviews in HCBS programs.
Jones, J., Coberly, S., Martineau, M. (May 11, 2012). Medicaid Managed Long-Term Services and Supports (MMLTSS): Increasing State Interest and Implications for Consumers, Quality of Care, and Providers and Costs. National Health Policy Forum. http://www.nhpf.org/library/details.cfm/2894. Accessed May 13, 2013.
This report recapped lessons learned from Medicaid MLTSS programs, identified the cost-savings and quality outcomes of these programs, and reviewed the actions taken by CMS in trying to help states move to MLTSS models. It also addresses consumer concerns and protections to be considered when implementing the MLTSS programs.
Kaiser Commission on Medicaid and the Uninsured. (2011). Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues to Consider. The Henry J. Kaiser Family Foundation. http://kff.org/medicaid/issue-brief/examining-medicaid-managed-long-term-service-and/. Accessed May 13, 2013.
This paper examines issues states may face when considering moving LTSS populations and benefits from FFS to managed care. The authors encourage states to appreciate amount of time, expertise, and financial resources needed to make MLTSS programs successful.
Konetzka R.T., Karon S.L., and Potter, D.E.B. (2012).Users of Medicaid Home and Community-Based Services Are Especially Vulnerable to Costly Avoidable Hospital Admissions. Health Affairs, (31). http://content.healthaffairs.org/content/31/6/1167.full.
This article reports on an analysis of Medicare and Medicaid data to identify the prevalence of potentially avoidable hospital admissions among users of Medicaid HCBS. The researchers found that users of Medicaid HCBS were particularly vulnerable to avoidable hospital admissions, compared to the full Medicaid and United States populations, and that these hospitalizations occur at substantial cost to the public payers.
Lind, A., Gore, S., Barnette, L., Somers, S. (November 2010). Profiles of State Innovation: Roadmap for Managing Long-Term Supports and Services. Center for Health Care Strategies, Inc. http://www.chcs.org/usr_doc/MLTS_Roadmap_112210.pdf. Accessed May 13, 2013.
This paper offers a roadmap, culled from state best practices, and highlights key elements for MLTSS that result in high-quality, consumer-focused, and cost-effective care.
Lipson, D., Libersky, J., Machta, R., Flowers, L., Fox-Grage, W. (July 2012). Keeping Watch: Building State Capacity to Oversee Medicaid Managed Long-Term Services and Supports. AARP Public Policy Institute. http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/keeping-watch-building-state-capacity-to-oversee-medicaid-managed-ltss-AARP-ppi-health.pdf. Accessed May 13, 2013.
This report addresses capacities that state Medicaid agencies need to monitor the performance of MLTSS programs and identifies promising practices in state oversight, as well as the monitoring capacities that should be in place when states begin to implement new or expanded MLTSS programs.
Lipson, D., Stone-Valenzano, C. (February 2013). The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program. MathematicaPolicy Research, Inc. http://www.mathematica-mpr.com/publications/pdfs/health/MFPfieldrpt11.pdf. Accessed May 13, 2013.
The report reviewed best practices and lessons learned from multiple states that have implemented both MFP programs and MLTSS. The key findings leading to increased synergy between MFP and MLTSS include identifying overlapping target groups, defining roles and responsibilities, harmonizing monitoring and reporting requirements, and creating other partnerships between MFP and MLTSS programs.
Maslow, K., Ouslander, J. (January 2012). Measurement of Potentially Preventable Hospitalizations. Long-Term Care Quality Alliance. http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images/PreventableHospitalizations_021512_2.pdf. Accessed September 26, 2103.
This white paper describes and analyzes quality measures that have been developed to identify potentially preventable hospitalizations. It was developed to provide information and recommendations to the Long-Term Care Quality Alliance to select quality measures and prioritize next steps to improve identification of potentially preventable hospitalizations for frail and chronically ill adults and older people.
METASTAR, Inc. External Quality Review Report: Wisconsin Medicaid Managed Long-Term Care- Family Care, Family Care Partnership and Program of All-Inclusive Care for the Elderly: State Fiscal Year 2011-2012. http://www.dhs.wisconsin.gov/ltcare/statefedreqs/eqro11-12.pdf. Accessed June 21, 2013.
External Quality Review report for Wisconsin's Medicaid MLTSS programs, July 2011-June 2012.
Minnesota Department of Human Services and Public Consulting Group. (February 15, 2013). Initial Report on the Value of Minnesota Health Care Programs (MHCP) Managed Care, as Compared to Fee-for-Service. https://mplus.mnpals.net/vufind/Record/007672698. Accessed September 16, 2013.
This paper a preliminary report on the value of Medicaid managed care in Minnesota, relative to FFS. In addition to some initial findings it lays out the criteria the final report will use for evaluating the value of managed care.
Minnesota Department of Human Services, Performance Measurement and Quality Improvement Division. (October 2011). Managed Care Public Programs 2012 Quality Strategy. https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4538-ENG. Accessed August 20, 2013.
This report describes the Minnesota Department of Human Services' strategy for assessing and improving the quality of health care services offered by managed care plans for people enrolled in Medical Assistance and MinnesotaCare.
Mission Analytics Group. (February 2013). The Balancing Incentive Program: Implementation Manual. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long.... Accessed September 26, 2013.
This manual provides guidance to states in implementing the three structural changes in their systems of community-based LTSS: a No Wrong Door/Single Entry Point (NWD/SEP) eligibility determination and enrollment system; Core Standardized Assessment Instruments; and Conflict-Free Case Management..
National Committee for Quality Assurance. (March 2013). Integrated Care for People with Medicare and Medicaid. http://www.ncqa.org/portals/0/public%20policy/NCQAWhitePaper-IntegratedCareforPeoplewithMedicareandMedicaid.pdf. Accessed September 26, 2013.
This paper reviews strategies for measuring and evaluating quality and person-centeredness in integrated care systems.
National Home and Community-Based Quality Enterprise. (April 27, 2012). NQE Quality Brief: Mortality Investigation and Review in Medicaid Home and Community-Based Services Program.
This brief outlines issues states should consider when developing mortality investigation and review policies and procedures for Medicaid HCBS participant deaths.
Rivard, P., Jackson, B., Rachel, J., Seibert, J., Whitworth, T. (September 2013). Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Truven Health Analytics.
This report summarizes the quality requirements that states include in their contracts with MCOs for their Medicaid MLTSS programs.
Saucier, P., Kasten, J. Burwell, B., Gold, L. (2012). The Growth of Managed Long Term Services and Supports (MLTSS) Programs: A 2012 Update. Centers for Medicare and Medicaid Services. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/MLTSSP_White_paper_combined.pdf. Accessed August 8, 2013.
This paper reports the findings of a national environmental scan of all Medicaid MLTSS programs implemented as of June 2012 and a projection of future programs through January 2014.
Synovate. (April 10, 2009). Arizona Long Term Care System (ALTCS) Satisfaction Survey 2008: Report of Findings. http://www.azahcccs.gov/shared/Downloads/surveys/ALTCS_Satisfaction_Survey_2008-FullReport.pdf. Accessed August 22, 2013.
This report highlights the findings from a survey on satisfaction with care and services provided by the ALTCS for the Elderly and Physically Disabled (ALTCS-EPD) program and represent input from members across all eight ALTCS-EPD program contractors in all three of the care settings in which members reside (nursing facility, assisted living, and home).
Texas Medicaid Managed Care STAR+PLUS Behavioral Health Survey Report Fiscal Year 2011. http://www.hhsc.state.tx.us/reports/2013/EQRO-Behavioral-Health-FY2011.pdf. Accessed July 17, 2013.
This report, prepared by the Texas' EQRO, provides results from the state fiscal year 2011 STAR+PLUS Behavioral Health Survey which documents customer satisfaction and experience of behavioral health services.
Texas Medicaid Managed Care STAR+PLUS Home- and Community-Based Services Waiver Study Report Contract Year 2012. http://www.hhsc.state.tx.us/reports/2013/EQRO-STAR-PLUS-Waiver.pdf. Accessed July 17, 2013.
The purpose of this study was to: (1) describe and categorize the types of HCBS provided to Texas STAR+PLUS members; (2) examine perceptions STAR+PLUS members and service coordinators about the process of developing an ISP; (3) assess the involvement of members and their families in decisions regarding their care; and (4) assess members' experiences and satisfaction with the HCBS they receive.
Texas STAR+PLUS Program Adult Member Survey Report, Fiscal Year 2011. http://www.hhsc.state.tx.us/reports/2012/EQRO-Texas-STARPLUS-Audlt-Member-Survey-FY2011-Attachment-1.pdf. Accessed July 17, 2013.
This report provides results from the fiscal year 2011 STAR+PLUS Adult Member Survey and offers information on health status as well as member experiences and general satisfaction with the care they receive through the Texas STAR+PLUS program.
Truven Health Analytics (as The MEDSTAT Group, Inc.). Participant Experience Survey (PES) Tools. For the Centers for Medicare and Medicaid Services. http://nasuad.org/hcbs/article/participant-experience-survey-pes-tools. Accessed March 5, 2014.
These interview tools capture feedback directly from waiver participants about the supports and services they receive through home and community-based services waivers. States can use the data gathered through the surveys to calculate performance indicators to monitor quality within waivers. There is one PES geared for frail elderly and adults with physical disabilities and one for adults with intellectual and/or developmental disabilities.
Under Development by the National Association of State Units on Aging and Disability--NCI-AD--Expanding the National Core Indicators for Aging and Disability Services. Presented at the 2013 NASUAD HCBS Conference. http://www.nasuad.org/documentation/HCBS_2013/Presentations. Accessed October 11, 2013.
This presentation addressed expanding the National Core Indicators for the aged and disabled populations.
Wisconsin Department of Health Services, Family Care. 2010 Family Care Member Satisfaction Survey Results. http://www.dhs.wisconsin.gov/LTCare/Reports/PDF/satisfactionrpt2010.pdf. Accessed June 10, 2013.
This report discusses the program findings and methodology of the satisfaction survey conducted by the State of Wisconsin on its Family Care MLTSS program.
Wisconsin Department of Health Services. Family Care Contract between Department of Health Services Division of Long Term Care and <<Name of MCO>>. http://www.dhs.wisconsin.gov/ltcare/statefedreqs/cy2012mcocontract.pdf. Accessed June 21, 2013.
This document is the Family Care Contract between the Wisconsin Department of Health Services and MCOs. It includes contract requirements for MCO governance, consumer and member involvement, eligibility, enrollment and disenrollment, among others.
Wisconsin Department of Health Services, Division of Long-Term Care. Long-Term Care In Motion: Wisconsin's Long Term Care Programs. http://www.dhs.wisconsin.gov/publications/P0/p00318_2011.pdf. Accessed June 21, 2013.
2011 report on Wisconsin's IRIS and Family Care Programs.
Zubritsky, C., Abbott, K., Hirschman K., Bowles K., Foust, J., Naylor, M. (2012). Health-Related Quality of Life: Expanding a Conceptual Framework to Include Older Adults Who Receive Long-Term Services and Supports. The Gerontologist, 53(2): 205-210. http://gerontologist.oxfordjournals.org/content/53/2/205.full.pdf+html. Accessed May 13, 2013.
Journal article exploring multi-dimensional health-related quality of life models and concepts.