NAHC Submits Comments on Medicaid Managed Care Proposed Rule
July 28, 2015 08:29 AM
The National Association for Home Care & Hospice (NAHC) recently submitted comments to the Center for Medicare & Medicaid Services (CMS) on a proposed rule addressing Medicaid managed care (click here to see previous NAHC Report article regarding announcement of the proposed rule). The comments submitted by NAHC reflect those expressed by the beneficiary advocacy community, and also highlight several issues specific to provider interests.
In a letter to CMS Acting Administrator Andy Slavitt, NAHC expressed support for the proposed rule’s establishment of a framework for developing Medicaid managed care models, particularly Medicaid Long Term Services and Supports (MLTSS). “NAHC commends [CMS] for offering a proposed rule for public comment that is a thoughtful and comprehensive consideration of the issues and concerns presented with Medicaid managed care,” NAHC stated in the letter. “We share the view that it is essential that some level of structure be implemented to guide the ever-increasing shift of Medicaid programs to managed care models, particularly with MLTSS.”
While expressing support for the proposed rule’s overall framework, NAHC expressed several recommendations to improve it. One NAHC recommendation is to require states and contractors to develop plans to comply with the Americans with Disabilities Act (ADA) and the U.S. Supreme Court decision in Olmstead v. L.C. While the CMS proposed rule references compliance with the ADA and Olmstead, NAHC believes that it should include “a specific obligation” for state Medicaid plans and contracting MLTSS plans to establish compliance plans with regards to Medicaid managed care development. “Such a compliance plan would aid in CMS’s review of any pertinent state plan amendments or waiver applications from a state,” NAHC stated. “With respect to the MLTSS plans, a compliance plan requirement would help operationalize compliance, making it an achievable process measure and an outcome goal that can be better audited.”
Compliance for a MLTSS program might include standards such as minimum data sets, periodic reviews, benchmarks, public reporting, in addition to minimum standards for procedures in areas such as discharge planning, enrollee service choice, information and education, care plan development, and service authorization. For a MTLSS home care program, the compliance plan should ensure “that a beneficiary has a choice of all models of care delivery” along with a level of care “sufficient to meet the individual’s needs rather than a financial budget.”
NAHC also recommends modifying the proposed rule to include standards on provider rate setting. “Experience to date indicates a high risk that MLTSS plans will set payment rates at below cost levels thereby triggering risks that care access or quality could be compromised,” NAHC stated in the letter. Standards to prevent such an outcome should include requirements that an MLTSS plan determine the reasonable cost for the delivery of care and the fair market value for services in the relevant geographic area. The plan should also report to the state Medicaid program at least 3 months prior to the effective date if there is any reduction in provider payment rates. In addition, the state should establish a rate review process that allows providers to submit evidence of cost and fair market value, and that permits the state to deny a MLTSS plan’s proposed reduction in payment rates.
Other NAHC recommendations include:
Expand the enrollment period for MLTSS beneficiaries from a 14-day period to a period of 30 days at minimum, preferably 60 days.
Expand transition policy requirements in order to minimize any disruption in care for the MLTSS beneficiary. Separate sets of requirements should address each type of transition involving MLTSS, including transitions between fee-for-service to managed care, transitions from one managed care plan to another, and provider changes to network modifications.
Establish requirements to ensure that each network provides the MLTSS beneficiary with timely access to care and reasonable levels of choice, including a minimum number of providers, state audits to ensure access to care, and access to out-of-network services without added cost if the MLTSS plan is unable to provide timely access to network services.
Modify stakeholder engagement to require the inclusion of each type or model of MLTSS provider.
Modify appeals process to allow providers or services to represent MLTSS beneficiaries or have direct appeal rights. Include an anti-retribution provision to protect the provider from any negative reaction from the MLTSS plan in the event of appeal.
Click here to read the full letter from NAHC providing comments on the proposed rule. For more information about the proposed rule on the CMS website, click here.