NAHC Policy Specialist Attends National HCBS Conference
October 3, 2014 08:36 AM
NAHC policy specialist, Michelle Martin, attended the 2014 National Association of States United for Aging and Disabilities (NASUAD) Home and Community Based Services Conference held last month. The conference week began with a day-long intensive on “Managed Long Term Services and Supports: a 360° View,” followed by several days of information-packed workshops, including a session on the ACA Employer Mandate with Medicaid Council Executive Director, Bill Dombi, and several other home care providers. To view the full agenda and materials from the sessions, including videos of the plenary sessions, see the NASUAD website.
The conference agenda offered sessions on a wide variety of interesting topics. Presenters for the sessions included speakers from the Centers for Medicare and Medicaid Services, state Medicaid departments, academic institutions, stakeholder associations, managed care organizations (MCOs), and community-based organizations. The audience was made up, largely, of people from various divisions of state Medicaid agencies, community based organizations, and some health plans. Very few Medicaid home care providers were represented in the speaking faculty or audience.
Managed Long-Term Services and Supports
Managed long-term services and supports (MLTSS) programs are considered successful from the perspectives of CMS, states, and health plans. During the first day MLTSS intensive, state commissioners and deputy directors from New Jersey, Kansas, Florida, and Texas all shared their experience of implementing MLTSS. Each state representative discussed the path to managed care, the preparation that went into planning for the transition, and the overall success of the transition. MCOs offered a similar perspective of success but included their focus on providing patient centered care. When the advocacy organization representatives took the stage, the focus was on training advocates to operate within the managed care space. The message was that state level advocates need to be fairly sophisticated to navigate through the maze of managed care and that consumer engagement is critical to success within managed care. From the perspective of the CMS, states are very involved in the transition to MLTSS and states are remaining very involved with the individual health plans after implementation. While the proclamation of resounding success seemed off-base given the real-world experience of Council membership, the positive emphasis was not surprising. The focus of the conference overall was on the more technical aspects of home and community based services (HCBS).
The sessions over the remaining two-and-a-half days of the conference were packed with information. The topics ranged from a basic “Medicaid 101” class to the intersection of housing and health to technology used in HCBS. Some sessions were very technical, such as how a state can best audit a managed care health plan’s performance integrity, while others were aimed at sharing information on technology trends and technology currently under development. In all sessions, it was encouraging to see the audience’s level of interest in learning about all aspects of HCBS.
A few points were notable from the conference. First, the Department of Health and Human Services (HHS) has funded a project through the National Quality Forum (NQF) that will focus on addressing performance measure gaps in HCBS with the goal of enhancing the quality of community living. The project has been under development for some time but was only approved by HHS for moving forward on September 12, 2014. During the conference, Michelle took the opportunity to meet with Sarah Lash, who is a senior director at NQF. Ms. Lash shared the Measuring HCBS Quality website and is eager to receive committee nominations from the Council once the nominations process opens up in November. During the conference it was clear that quality care is a significant issue, but how to measure it remains somewhat of a mystery.
MCOs. Other interesting takeaways were the issues key to Medicaid MCOs. According to representatives from a few large Medicaid MCOs, health plans are looking to form partnerships, with a focus on community based organizations (CBOs) such as Area Agencies on Aging (AAAs) and Aging and Disability Resource Centers (ADRCs). The issue facing many CBOs, and limiting partnership opportunities, is “scalability”. Because CBOs often represent a small group of Medicaid beneficiaries, either because of the location or because the organization serves a limited type of beneficiary, MCOs find it difficult to partner with the smaller groups. Instead, MCOs search for CBOs that reach a wide range/high volume of beneficiaries. The MCOs featured at the conference suggested that CBOs in a particular geographic region partner together to create a unified voice and partner with the MCO instead of trying to work with the MCO on an individual basis. The MCOs find it easier to work with one, unified group than to work with several groups, all of which have the same interests and intention. There is a possibility that Medicaid home care providers can partner with each other and with CBOs to create a larger, unified voice. Doing so would increase opportunity for creating meaningful relationships with Medicaid MCOs. The other notable revelation from the MCOs was their realization of the difficulty that results from providers and CBOs needing to invest in sophisticated IT systems to keep up with the billing and reporting demands of the MCOs. The difficulty is worsened when some providers/CBOs have invested in systems that are not compatible across all IT systems. The MCO representatives suggested that some organizations are wiling to help with the cost of an appropriate IT system given that it is in the MCOs best interests to work smoothly across all involved organizations. The overall takeaway was that providers and community based organizations should not hesitate to partner together to create scalability and have a stronger voice when dealing with Medicaid managed care organizations.
Technology. Finally, the conference included an exciting focus on technology with several sessions dedicated to the various uses of technology in HCBS. The sessions examined technology that is currently used as well as technology that is under development and being beta tested in some states. The beta tests include new technology for remote patient monitoring, patient ride sharing, remote grocery shopping and many other day-to-day activities that are simplified through the use of technology. States are reviewing policies in order to allow for access to adequate funding for the technology. There are many new and innovative ideas under way, with the developing companies paying close attention to how well the technology works not only for the caregiver, but also for the patient. It was exciting to learn about the coming technology as well as the policy changes states are making to open up funding for the innovative tools.
All in all, the conference was an interesting learning experience. It allowed for a closer look at where there may be room for miscommunication regarding the transition to MLTSS at both the state and MCO levels. Both states and MCOs are overwhelmed with navigating the correct path to working together, which leaves little time for involving the providers and those who are truly affected by the transition process. States are dedicated to requiring patient centered care but developing that system along with transitioning services to managed care and creating appropriate contracts at the same time as exploring waiver possibilities can be overwhelming.
NAHC will continue to work toward partnerships with Medicaid MCOs and will also work with the Forum of State Associations to explore the possibility for partnering with appropriate community based organizations in effort to create a more powerful, unified voice when dealing with the MCOs. NAHC will also work with the Forum of State Associations to determine whether there are beneficial relationships at the federal and state levels that need to be fostered in order to help providers work within managed care. By all indications, managed care is the future of long term services and supports and it is critical to find a way to effectively partner with all affected stakeholders.