Quality in Managed Long-Term Services and Supports Programs. Notes

11/01/2013

  1. Saucier P., Kasten J., Burwell B., and 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.

  2. Medicaid managed care regulations may be found in Code of Federal Regulations (CFR) 438: http://www.gpo.gov/fdsys/granule/CFR-2011-title42-vol4/CFR-2011-title42-vol4-part438/content-detail.html. Accessed August 30, 2013.

  3. Centers for Medicare and Medicaid Services, Center for Medicaid & CHIP Services, 2013. Guidance to States Using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs. May 20, 2013. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf. Accessed August 30, 2013.

  4. While we use the term "MCO" in this report to refer to entities who manage MLTSS services under contract to the state, technically the plans in Michigan, North Carolina and Pennsylvania are Pre-paid Inpatient Health Plans (PIHPs).

  5. Rivard P., Jackson B., Rachel J., Seibert J., and Whitworth T. Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Truven Health Analytics, Draft: August 31, 2013.

  6. AHCCCS--Arizona Health Care Cost Containment System.

  7. AAADs are responsible for information and referral activities and sit outside the MCOs.

  8. Money-Follows-the-Person Demonstration.

  9. National Committee for Quality Assurance. Integrated Care for People with Medicare and Medicaid. March 2013. http://www.ncqa.org/portals/0/public%20policy/NCQAWhitePaper-IntegratedCareforPeoplewithMedicareandMedicaid.pdf. Accessed September 26, 2013.

  10. Lind A, Gore S, Barnette L, and Sommers S. Profiles of State Innovation: Roadmap for Managing Long-Term Supports and Services. Center for Health Care Strategies. November 2010. http://www.chcs.org/usr_doc/MLTS_Roadmap_112210.pdf. Accessed September 26, 2013.

  11. Dembner A. Putting Consumers First Promising Practices for Medicaid Managed Long-Term Services and Supports, Community Catalyst. January 2013. http://www.communitycatalyst.org/doc_store/publications/putting_consumers_first_LTSSmanagedcare.pdf. Accessed September 26, 2013.

  12. Konetzka RT, Karon SL, and Potter DEB. Users of Medicaid Home and Community-Based Services Are Especially Vulnerable to Costly Avoidable Hospital Admissions. Health Affairs 31, 2012. http://content.healthaffairs.org/content/31/6/1167.full.

  13. Galantowicz S. Environmental Scan of Measures for Medicaid Title XIX Home and Community Based Services: Final Report. AHRQ Publication No. 10-0042-EF. Agency for Healthcare Research and Quality, Rockville, MD. June 2010. http://www.ahrq.gov/research/ltc/hcbsreport. Accessed June 26, 2013.

  14. Maslow K, Ouslander J. Measurement of Potentially Preventable Hospitalizations. Long-Term Care Quality Alliance. January 2012. http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images/PreventableHospitalizations_021512_2.pdf. Accessed September 26, 2013.

  15. Centers for Medicare and Medicaid Services, Code of Federal Regulations, 42 CFR 438.206.c.1.i-vi.

  16. Government Accountability Office. Medicaid Home and Community-Based Waivers: CMS Should Encourage States to Conduct Mortality Reviews for Individuals with Developmental Disabilities. GAO-08-529 May 23, 2008.

  17. National Home and Community-Based Quality Enterprise. NQE Quality Brief: Mortality Investigation and Review in Medicaid Home and Community-Based Services Program. April 27, 2012.

  18. AAAD (Tennessee).

  19. FEA, for members directing their own services (Tennessee).

  20. CFR 438.240.

  21. Mission Analytics Group. The Balancing Incentive Program: Implementation Manual. February 2013. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long.... Accessed September 26, 2013.

  22. Centers for Medicare and Medicaid Services. Planning and Demonstration Grant for Testing Experience and Function Tools in Community-Based Long Term Services and Supports (TEFT) (CMS-1H1-13-001). June 27, 2013. http://www.grants.gov/web/grants/view-opportunity.html?oppId=195253. Accessed September 26, 2013.

  23. In those instances where a state appears not to have implemented all the essential quality elements delineated in CMS' guidance document, we remind the reader that our data collection occurred prior to, and approximately contiguous with, the release of CMS' directive in May 2013. As such, this study's description of state practices (or their absence) to assess compliance with federal expectations should be avoided.

  24. CAHPS is actually a family of measure sets, focusing on consumers' experience with different aspects of the health care delivery. Separate CAHPS instruments have been developed and tested for assessing consumer experience of health plans, hospitals, dental services, Medicaid, home health, nursing home, prescription drug plan, clinician and group, behavioral health, patient-centered medical home, and Medicare Advantage plans.

  25. Thurston Toppe, K. NCQA Medicaid Managed Care Toolkit. National Committee for Quality Assurance. March 2012. http://www.ncqa.org/Portals/0/Public%20Policy/2012_NCQA_Medicaid_Managed_Care_Toolkit_Summary_-_March_2012_Final.pdf. Accessed September 26, 2013.

  26. 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.

  27. The state legislature mandated that as of October 1, 2013, the number of PIHPs will be reduced to ten new regional entities for simplification and equity statewide and to prepare mental health and developmental disability systems for increased integrated care approaches.

  28. The PIHPs must also be a designated Community Mental Health Services Program.

  29. The QIC is a stakeholder group comprised of consumers, advocates, provider organizations, PIHPs and Community Mental Health Service Programs.

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