Until recently, most state Medicaid programs have excluded people with disabilities from managed care because of their complex needs. But that’s changing. Twenty states now have shifted their MLTSS program to private managed-care companies—largely insurers—compared with eight in 2004. Overall, Medicaid spent $146 billion on LTSS in fiscal 2014, according to the CMS.
Officials say MLTSS programs enable delivery of more coordinated care and direct patients away from expensive nursing home settings.
However, the CMS has not established criteria for what data states must submit to determine appropriate rates.
“Without strong data, states and the federal government risk paying rates that are too low, which could result in quality and access concerns for beneficiaries, or rates that are too high, which diverts limited Medicaid dollars to [plan] profit and away from needed care,” the GAO said in a report.
The agency suggests that the CMS require all states to report on progress toward achieving MLTSS program goals and provide guidance with minimum standards for validating encounter data, which is information on care a beneficiary received.
In a December letter, HHS officials say they agreed with the recommendations and were drafting guidance to implement the ideas.
Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor’s degree from DePaul University in 2007.