By: Community Catalyst
As newÂ state demonstrationsÂ to improve and integrate care for Medicare-Medicaid enrollees (also known as â€śdual eligiblesâ€ť) move forward, healthÂ plans and provider groups (here, referred to collectively by the term â€śdelivery systemsâ€ť) must employ meaningful consumer engagement strategies.Â Federal guidanceÂ from the Centers for Medicare and Medicaid Services calls upon states to ensure the voices of older adults, persons with disabilities, and their caregivers are heard in the design, implementation, and oversight of the demonstrations. Their voices are vital because Medicare-Medicaid enrollees have complex medical and social needs, as well as personal preferences, that all members of the delivery system need to understand and respect in order to truly provide person-centered care. Community Catalyst believes that consumer engagement, done well, fosters an atmosphere of active, ongoing collaboration and conversation that will benefit consumers and their caregivers, health plans and provider groups, and ultimately transform the health care delivery system. To ensure meaningful consumer engagement occurs,Â Voices for Better HealthÂ created this Toolkit for delivery systems to use as they implement effective strategies of engagement.
Medicaid Managed Care Rules: Key Considerations for Aging Advocates
By: Justice in Aging
On May 27, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to update the Medicaid managed care regulations for the first time in over ten years. The â€śmassive,â€ť â€śmilestone,â€ť â€śsweeping new regulationsâ€ť are receiving a lot of attention in the health policy world.Â But what do they mean for older adults?
Justice in Agingâ€™s issue brief, Medicaid Managed Care Rules: Key Considerations for Aging Advocates, breaks down the key areas of importance for older adults and their advocates.Â This issue briefÂ explores eight key areas, focusing on what they mean for long-term services and supports and older Medicaid beneficiaries:
- Defining and Codifying MLTSS
- Enrollment and Disenrollment
- Appeals and Grievances
- Beneficiary Support System
- Network Adequacy
- Service Authorization and Care Continuity
- Quality Measurement and Improvement
The six MFP grantees this study highlights offer several lessons that can help other states enhance their program models to better serve people with diverse support needs:
- First,Â thorough identification of a personâ€™s needs and preferences early in the transition process is essential to facilitate timely linkages to services in the community and avoid reinstitutionalization.
- Second,Â the federal funding made available to MFP grantees gives states the ability to test new service innovations on a small scale that help meet participantsâ€™ support needs in the community; states that performed better on key outcome measures made good use of this flexibility to ensure that all participants received appropriate and timely supports in the community.
- Third, quality monitoring systems are key to track participantsâ€™ outcomes in the community. Several states included in this study use the knowledge gained from its evaluation of quality monitoring data to improve service delivery for participants.
- Finally, MFP programs in these states formed strong partnerships with stakeholders, which led to close coordination in service delivery and propelled system transformation efforts forward.