Medicaid-Focused Educations Sessions from the March on Washington Speak to Medicaid’s Growing Role in Home Care and Hospice
March 26, 2014 07:37 AM
NAHC Vice President for Law Bill Dombi stated in this year’s opening General Session that, “Medicaid is the largest home care provider by far. It dwarfs Medicare and now spends about $60 billion a year on home care.” The increasing prominence of Medicaid in home care and hospice was reflected in the increase of Medicaid programs during this year’s March on Washington.
On March 24, the National Council on Medicaid Home Care - a NAHC affiliate - held an educational session for the March on Washington entitled “Medicaid Managed Long Term Services and Supports: This is the Future!” Michelle Martin, the Council’s Director of Policy, moderated. The session featured the following speakers:
Sherl Brand, Chief External Affairs Officer & VP/Business Development, VNA Health Group
Christopher Palmieri, President VNS of New York
Michael Brown, BAYADA Home Health Care
Richard Fredrickson, Sr. VP, Long Term Care, Centene Corporation
Topics of discussion included: the overall transition of the long term services and supports (LTSS) population into managed care; the use of technology in managed LTSS; the importance of providers and plans communicating and educating each other; concerns regarding credentialing and claims submission; and discussion of what plans think determines “quality providers.”
While addressing concerns, all panelists stressed the importance of cooperation between plans and providers in transitioning to manage care. “We believe in managed care for the LTSS population because we believe that it hits the goals of the Triple Aim: Access, Quality, and Lower Costs,” said Mr. Palmieri. “With managed care, you can continue to have a relationship beneficial to consumers, providers, and plans.”
Mr. Fredrickson commented: “We see further penetration of managed care into the Medicaid space. With that, we need providers and payers to come together more effectively on the part of the consumer. This is especially relevant in the LTSS space, because of the complex needs of the consumers and their co-morbid conditions in particular.”
Mr. Brown agreed. “This session is uniquely important,” he stated. “It allows providers and plans to join together in the best interest for clients in this important transition.”
Mrs. Brand stated: “If we’re going to see successful rollouts of MLTSS, there has to be communication and collaborations between providers, plans and their states. Otherwise, all parties will encounter obstacle after obstacle.”
In another Medicaid-focused session held on March 24, a panel of experts addressed attendees during an educational session entitled, “The Future of Medicaid: CMS Panel of Experts.” The panel consisted of the followg experts:
Edo Banach, Senior Advisor, Acting Director, Models Demonstrations and Analysis Group, Medicare Medicaid Coordination Office (MMCO), Centers for Medicare and Medicaid Services
Dianne Kayala, Technical Director, Disabled and Elderly Health Program Group, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services
Ralph Lollar, Disabled and Elderly Health Programs Group, Center for Medicaid, Centers for Medicare and Medicaid Services
Mr. Banach spoke first, talking about the status of the demonstrations that MMCO was currently implementing, including the Financial Alignment Initiative for the dual eligible population, as well as another demonstration to reduce preventable inpatient hospitalizations among residents of nursing facilities.
Ms. Kayala then spoke extensively about the extent of implementation of managed long-term services and supports (MLTSS) nationwide.
Mr. Lollar then talked about the state of rebalancing away from nursing homes and towards home and community-based care. He gave a quick status report on the Balanced Incentive Payments (BIP) and Money Follows the Person (MFP) programs, and then a synopsis of the new Home and Community-based services (HCBS) rule.
For a previous Council brief on the rule, click here.
Ms. Kayala then gave a brief presentation on recent program integrity findings in home care, as reported by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services. She stated that noncompliance ran the gamut and ranged from billing for services not rendered to not providing adequate documentation for services billed.