FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2083058438> ?p ?o ?g. }

• W2083058438 endingPage "17" @default.
• W2083058438 startingPage "1" @default.
• W2083058438 abstract "Just when post-acute/long-term care practitioners got used to the Affordable Care Act, accountable care organizations, and quality assurance and performance improvement, along comes another new complicated initiative to wrap their minds around – managed long-term services and supports. MLTSS includes state programs that deliver long-term care services and supports through capitated managed care plans. Also known as Medicaid managed care, MLTSS represents a move from traditional fee-for-service payment systems as a way to control costs, increase efficiency, and enable more people to minimize their stays in PA/LTC facilities and return to their homes as quickly as possible after an injury or illness.Not all states currently have MLTSS programs, but they are becoming more prevalent. Only eight states had Medicaid managed care programs in 2004. By 2012, that number had grown to 16; currently about 30 states have Medicaid managed care programs, and the number is still growing. Participation in an MLTSS program is mandatory in some states and voluntary in others, although more states are requiring Medicaid beneficiaries to enroll in some form of managed care.According to federal regulations overseeing managed care delivery systems, a Medicaid managed care plan must have consumer protections in place, including a quality program, appeal and grievance rights, reasonable access to providers, and the right to change plans. States can use either a state plan or waiver authority to establish their Medicaid managed care plan, as long as they comply with these regulations. Medicaid managed care may involve managed care organizations that provide benefits in exchange for a monthly payment from the state, or it may be a limited benefit plan that resembles a health maintenance organization and provides specific benefits, such as mental health care. Alternately, a state's Medicaid managed care program may involve primary care case managers who receive monthly payments for care coordination, referrals, and various medical services.What Practitioners Should KnowAlthough Medicaid managed care doesn't affect how facilities care for residents or how practitioners provide care, it likely will impact lengths of stay, patients' movement through the care continuum, and the use of home- and community-based supports and services. So what does Medicaid managed care mean for practitioners?“Physicians, nurse practitioners, and physician assistants likely will see more efforts to convert and transition people out of long-term care facilities and into home-based care and community settings,” according to Mike Cheek, American Health Care Association vice president of Medicaid and long-term care policy. Practitioners will need to start working with case managers and others connected to Medicaid managed care plans to focus on transitioning some patients out of long-term care settings and diverting others from post-acute back to the community, he said. Mr. Cheek added that practitioners should realize that this will spell the end for Medicaid fee-for-service in states that adopt Medicaid managed care. Principles of CareIn a Medicaid Managed Care Long Term Services and Supports State Affiliate Primer, Toolkit and Resource Guide, Mike Cheek and Christopher Puri, an attorney at Bradley Arant Boult Cummings, LLP, in Nashville, TN, identified several principles to ensure access, choice, and quality for residents and patients in Medicaid managed care, or MLTSS: 1.MLTSS must improve access and quality first.2.States and plans should possess demonstrated experience before implementing or expanding MLTSS.3.States should offer individuals meaningful opportunities to make educated decisions.4.Independent grievances and appeals processes for individuals and providers should be established and adequately funded.5.MLTSS arrangements should ensure access to care when patients and residents need it.6.Ensuring administrative efficiency and consistency across plans is essential.7.Care coordination should produce efficiencies while improving health care experiences.8.Consider all views and perspectives when crafting MLTSS programs.9.Align provider reimbursements with program standards and access goals.“This represents a change in care,” Mr. Cheek told Caring for the Ages, and practitioners should be “deeply concerned. If people go from post-acute to long-stay then sent home and something happens that requires them to go back to the hospital, this has repercussions for both the hospital and the practitioner,” he explained. “Providers [such as hospitals or nursing homes], provider networks, and practitioners will be held accountable.”Practitioners will still oversee care decisions. “Plans are required to respond to physicians' input on medical decisions,” said Mr. Cheek. However, he added, “Whether they accept this input is another matter.” Practitioners can make the most of their input by working closely with the interdisciplinary team as patients are transitioned.“One role that physicians are being asked to fill in Medicaid managed care regards documentation of functional status,” added Melinda Henderson, MD, CMD, FAAHPM, senior clinical medical director at United Healthcare in Nashville, TN. “Plans are asking physicians to provide specific details about issues such as how patients are ambulating, transferring, and walking. This is important as ability to perform activities of daily living is a core component of eligibility for Medicaid.”Everything Old Is New AgainTen years ago, Dr. Henderson said, “I always thought of managed care as focused on utilization management – that was its major mechanism. Then 5–8 years ago there was a realization that utilization management wasn't enough, and we saw a bigger push regarding disease management.” Disease management programs began popping up, and there has been a greater emphasis on hands-on care that encourages patients to participate in managing their illnesses. Now, with Medicaid managed care, disease management is partnered with other initiatives that enable patients to utilize the lowest level of care for as long a time as possible – all without avoidable emergency room visits or hospitalizations.Dr. Henderson observed that the effort to divert patients away from long-term nursing home stays isn't new, and it is the way of the future. “It used to be that the nursing home was the end of the road. Patients were admitted, and they spent their remaining days there,” she said. In recent years, the rise of post-acute has supported the idea that many elders can return to the community after an illness, surgery, or injury.Nonetheless, barriers may prevent many patients from returning to their homes. For instance, Dr. Henderson said, “We had a significant waiting list for home care services in our state, so many patients had to remain in nursing homes and were resigned to the idea that they'd be there forever.” However, “Ultimately, it's the patient's decision. We can't force people out just because we think someone could be cared for less expensively in the community,” she said.Medicaid managed care programs are designed to eliminate the barriers to patients returning to the community and enable access to the supports and services that will make this possible. “If patients have unmet social needs – for example, they're not getting meals or their homes are falling into disrepair, these things can lead to physical or mental decline that results in rehospitalizations,” Dr. Henderson told Caring for the Ages. In post-acute/long-term care, this means identifying and wrapping the right supports around individuals so that they can maintain healthy living in the community. She noted, “How such systems are structured depends on the state. In Tennessee, we are responsible for beneficiaries wherever they are, so we are trying to identify individuals who want to move out of nursing homes. Then we are working to determine what supports and services will make that possible.”Dr. Henderson and Mr. Cheek urge practitioners to find out about Medicaid managed care programs in their states. Then, they suggest working with their facilities to strengthen care planning, processes, and documentation so that patients who want and are able to return the community have the resources, supports, tools, and knowledge to remain there safely. Just when post-acute/long-term care practitioners got used to the Affordable Care Act, accountable care organizations, and quality assurance and performance improvement, along comes another new complicated initiative to wrap their minds around – managed long-term services and supports. MLTSS includes state programs that deliver long-term care services and supports through capitated managed care plans. Also known as Medicaid managed care, MLTSS represents a move from traditional fee-for-service payment systems as a way to control costs, increase efficiency, and enable more people to minimize their stays in PA/LTC facilities and return to their homes as quickly as possible after an injury or illness. Not all states currently have MLTSS programs, but they are becoming more prevalent. Only eight states had Medicaid managed care programs in 2004. By 2012, that number had grown to 16; currently about 30 states have Medicaid managed care programs, and the number is still growing. Participation in an MLTSS program is mandatory in some states and voluntary in others, although more states are requiring Medicaid beneficiaries to enroll in some form of managed care. According to federal regulations overseeing managed care delivery systems, a Medicaid managed care plan must have consumer protections in place, including a quality program, appeal and grievance rights, reasonable access to providers, and the right to change plans. States can use either a state plan or waiver authority to establish their Medicaid managed care plan, as long as they comply with these regulations. Medicaid managed care may involve managed care organizations that provide benefits in exchange for a monthly payment from the state, or it may be a limited benefit plan that resembles a health maintenance organization and provides specific benefits, such as mental health care. Alternately, a state's Medicaid managed care program may involve primary care case managers who receive monthly payments for care coordination, referrals, and various medical services. What Practitioners Should KnowAlthough Medicaid managed care doesn't affect how facilities care for residents or how practitioners provide care, it likely will impact lengths of stay, patients' movement through the care continuum, and the use of home- and community-based supports and services. So what does Medicaid managed care mean for practitioners?“Physicians, nurse practitioners, and physician assistants likely will see more efforts to convert and transition people out of long-term care facilities and into home-based care and community settings,” according to Mike Cheek, American Health Care Association vice president of Medicaid and long-term care policy. Practitioners will need to start working with case managers and others connected to Medicaid managed care plans to focus on transitioning some patients out of long-term care settings and diverting others from post-acute back to the community, he said. Mr. Cheek added that practitioners should realize that this will spell the end for Medicaid fee-for-service in states that adopt Medicaid managed care. Principles of CareIn a Medicaid Managed Care Long Term Services and Supports State Affiliate Primer, Toolkit and Resource Guide, Mike Cheek and Christopher Puri, an attorney at Bradley Arant Boult Cummings, LLP, in Nashville, TN, identified several principles to ensure access, choice, and quality for residents and patients in Medicaid managed care, or MLTSS: 1.MLTSS must improve access and quality first.2.States and plans should possess demonstrated experience before implementing or expanding MLTSS.3.States should offer individuals meaningful opportunities to make educated decisions.4.Independent grievances and appeals processes for individuals and providers should be established and adequately funded.5.MLTSS arrangements should ensure access to care when patients and residents need it.6.Ensuring administrative efficiency and consistency across plans is essential.7.Care coordination should produce efficiencies while improving health care experiences.8.Consider all views and perspectives when crafting MLTSS programs.9.Align provider reimbursements with program standards and access goals.“This represents a change in care,” Mr. Cheek told Caring for the Ages, and practitioners should be “deeply concerned. If people go from post-acute to long-stay then sent home and something happens that requires them to go back to the hospital, this has repercussions for both the hospital and the practitioner,” he explained. “Providers [such as hospitals or nursing homes], provider networks, and practitioners will be held accountable.”Practitioners will still oversee care decisions. “Plans are required to respond to physicians' input on medical decisions,” said Mr. Cheek. However, he added, “Whether they accept this input is another matter.” Practitioners can make the most of their input by working closely with the interdisciplinary team as patients are transitioned.“One role that physicians are being asked to fill in Medicaid managed care regards documentation of functional status,” added Melinda Henderson, MD, CMD, FAAHPM, senior clinical medical director at United Healthcare in Nashville, TN. “Plans are asking physicians to provide specific details about issues such as how patients are ambulating, transferring, and walking. This is important as ability to perform activities of daily living is a core component of eligibility for Medicaid.” Although Medicaid managed care doesn't affect how facilities care for residents or how practitioners provide care, it likely will impact lengths of stay, patients' movement through the care continuum, and the use of home- and community-based supports and services. So what does Medicaid managed care mean for practitioners? “Physicians, nurse practitioners, and physician assistants likely will see more efforts to convert and transition people out of long-term care facilities and into home-based care and community settings,” according to Mike Cheek, American Health Care Association vice president of Medicaid and long-term care policy. Practitioners will need to start working with case managers and others connected to Medicaid managed care plans to focus on transitioning some patients out of long-term care settings and diverting others from post-acute back to the community, he said. Mr. Cheek added that practitioners should realize that this will spell the end for Medicaid fee-for-service in states that adopt Medicaid managed care. Principles of CareIn a Medicaid Managed Care Long Term Services and Supports State Affiliate Primer, Toolkit and Resource Guide, Mike Cheek and Christopher Puri, an attorney at Bradley Arant Boult Cummings, LLP, in Nashville, TN, identified several principles to ensure access, choice, and quality for residents and patients in Medicaid managed care, or MLTSS: 1.MLTSS must improve access and quality first.2.States and plans should possess demonstrated experience before implementing or expanding MLTSS.3.States should offer individuals meaningful opportunities to make educated decisions.4.Independent grievances and appeals processes for individuals and providers should be established and adequately funded.5.MLTSS arrangements should ensure access to care when patients and residents need it.6.Ensuring administrative efficiency and consistency across plans is essential.7.Care coordination should produce efficiencies while improving health care experiences.8.Consider all views and perspectives when crafting MLTSS programs.9.Align provider reimbursements with program standards and access goals. In a Medicaid Managed Care Long Term Services and Supports State Affiliate Primer, Toolkit and Resource Guide, Mike Cheek and Christopher Puri, an attorney at Bradley Arant Boult Cummings, LLP, in Nashville, TN, identified several principles to ensure access, choice, and quality for residents and patients in Medicaid managed care, or MLTSS: 1.MLTSS must improve access and quality first.2.States and plans should possess demonstrated experience before implementing or expanding MLTSS.3.States should offer individuals meaningful opportunities to make educated decisions.4.Independent grievances and appeals processes for individuals and providers should be established and adequately funded.5.MLTSS arrangements should ensure access to care when patients and residents need it.6.Ensuring administrative efficiency and consistency across plans is essential.7.Care coordination should produce efficiencies while improving health care experiences.8.Consider all views and perspectives when crafting MLTSS programs.9.Align provider reimbursements with program standards and access goals. In a Medicaid Managed Care Long Term Services and Supports State Affiliate Primer, Toolkit and Resource Guide, Mike Cheek and Christopher Puri, an attorney at Bradley Arant Boult Cummings, LLP, in Nashville, TN, identified several principles to ensure access, choice, and quality for residents and patients in Medicaid managed care, or MLTSS: 1.MLTSS must improve access and quality first.2.States and plans should possess demonstrated experience before implementing or expanding MLTSS.3.States should offer individuals meaningful opportunities to make educated decisions.4.Independent grievances and appeals processes for individuals and providers should be established and adequately funded.5.MLTSS arrangements should ensure access to care when patients and residents need it.6.Ensuring administrative efficiency and consistency across plans is essential.7.Care coordination should produce efficiencies while improving health care experiences.8.Consider all views and perspectives when crafting MLTSS programs.9.Align provider reimbursements with program standards and access goals. “This represents a change in care,” Mr. Cheek told Caring for the Ages, and practitioners should be “deeply concerned. If people go from post-acute to long-stay then sent home and something happens that requires them to go back to the hospital, this has repercussions for both the hospital and the practitioner,” he explained. “Providers [such as hospitals or nursing homes], provider networks, and practitioners will be held accountable.” Practitioners will still oversee care decisions. “Plans are required to respond to physicians' input on medical decisions,” said Mr. Cheek. However, he added, “Whether they accept this input is another matter.” Practitioners can make the most of their input by working closely with the interdisciplinary team as patients are transitioned. “One role that physicians are being asked to fill in Medicaid managed care regards documentation of functional status,” added Melinda Henderson, MD, CMD, FAAHPM, senior clinical medical director at United Healthcare in Nashville, TN. “Plans are asking physicians to provide specific details about issues such as how patients are ambulating, transferring, and walking. This is important as ability to perform activities of daily living is a core component of eligibility for Medicaid.” Everything Old Is New AgainTen years ago, Dr. Henderson said, “I always thought of managed care as focused on utilization management – that was its major mechanism. Then 5–8 years ago there was a realization that utilization management wasn't enough, and we saw a bigger push regarding disease management.” Disease management programs began popping up, and there has been a greater emphasis on hands-on care that encourages patients to participate in managing their illnesses. Now, with Medicaid managed care, disease management is partnered with other initiatives that enable patients to utilize the lowest level of care for as long a time as possible – all without avoidable emergency room visits or hospitalizations.Dr. Henderson observed that the effort to divert patients away from long-term nursing home stays isn't new, and it is the way of the future. “It used to be that the nursing home was the end of the road. Patients were admitted, and they spent their remaining days there,” she said. In recent years, the rise of post-acute has supported the idea that many elders can return to the community after an illness, surgery, or injury.Nonetheless, barriers may prevent many patients from returning to their homes. For instance, Dr. Henderson said, “We had a significant waiting list for home care services in our state, so many patients had to remain in nursing homes and were resigned to the idea that they'd be there forever.” However, “Ultimately, it's the patient's decision. We can't force people out just because we think someone could be cared for less expensively in the community,” she said.Medicaid managed care programs are designed to eliminate the barriers to patients returning to the community and enable access to the supports and services that will make this possible. “If patients have unmet social needs – for example, they're not getting meals or their homes are falling into disrepair, these things can lead to physical or mental decline that results in rehospitalizations,” Dr. Henderson told Caring for the Ages. In post-acute/long-term care, this means identifying and wrapping the right supports around individuals so that they can maintain healthy living in the community. She noted, “How such systems are structured depends on the state. In Tennessee, we are responsible for beneficiaries wherever they are, so we are trying to identify individuals who want to move out of nursing homes. Then we are working to determine what supports and services will make that possible.”Dr. Henderson and Mr. Cheek urge practitioners to find out about Medicaid managed care programs in their states. Then, they suggest working with their facilities to strengthen care planning, processes, and documentation so that patients who want and are able to return the community have the resources, supports, tools, and knowledge to remain there safely. Ten years ago, Dr. Henderson said, “I always thought of managed care as focused on utilization management – that was its major mechanism. Then 5–8 years ago there was a realization that utilization management wasn't enough, and we saw a bigger push regarding disease management.” Disease management programs began popping up, and there has been a greater emphasis on hands-on care that encourages patients to participate in managing their illnesses. Now, with Medicaid managed care, disease management is partnered with other initiatives that enable patients to utilize the lowest level of care for as long a time as possible – all without avoidable emergency room visits or hospitalizations. Dr. Henderson observed that the effort to divert patients away from long-term nursing home stays isn't new, and it is the way of the future. “It used to be that the nursing home was the end of the road. Patients were admitted, and they spent their remaining days there,” she said. In recent years, the rise of post-acute has supported the idea that many elders can return to the community after an illness, surgery, or injury. Nonetheless, barriers may prevent many patients from returning to their homes. For instance, Dr. Henderson said, “We had a significant waiting list for home care services in our state, so many patients had to remain in nursing homes and were resigned to the idea that they'd be there forever.” However, “Ultimately, it's the patient's decision. We can't force people out just because we think someone could be cared for less expensively in the community,” she said. Medicaid managed care programs are designed to eliminate the barriers to patients returning to the community and enable access to the supports and services that will make this possible. “If patients have unmet social needs – for example, they're not getting meals or their homes are falling into disrepair, these things can lead to physical or mental decline that results in rehospitalizations,” Dr. Henderson told Caring for the Ages. In post-acute/long-term care, this means identifying and wrapping the right supports around individuals so that they can maintain healthy living in the community. She noted, “How such systems are structured depends on the state. In Tennessee, we are responsible for beneficiaries wherever they are, so we are trying to identify individuals who want to move out of nursing homes. Then we are working to determine what supports and services will make that possible.” Dr. Henderson and Mr. Cheek urge practitioners to find out about Medicaid managed care programs in their states. Then, they suggest working with their facilities to strengthen care planning, processes, and documentation so that patients who want and are able to return the community have the resources, supports, tools, and knowledge to remain there safely." @default.
• W2083058438 created "2016-06-24" @default.
• W2083058438 creator A5008624834 @default.
• W2083058438 date "2015-02-01" @default.
• W2083058438 modified "2023-10-16" @default.
• W2083058438 title "Medicaid Managed Care Lifts Barriers to Home Care" @default.
• W2083058438 doi "https://doi.org/10.1016/j.carage.2015.01.002" @default.
• W2083058438 hasPublicationYear "2015" @default.
• W2083058438 type Work @default.
• W2083058438 sameAs 2083058438 @default.
• W2083058438 citedByCount "0" @default.
• W2083058438 crossrefType "journal-article" @default.
• W2083058438 hasAuthorship W2083058438A5008624834 @default.
• W2083058438 hasConcept C144133560 @default.
• W2083058438 hasConcept C159110408 @default.
• W2083058438 hasConcept C160735492 @default.
• W2083058438 hasConcept C17744445 @default.
• W2083058438 hasConcept C199539241 @default.
• W2083058438 hasConcept C2776534028 @default.
• W2083058438 hasConcept C71924100 @default.
• W2083058438 hasConceptScore W2083058438C144133560 @default.
• W2083058438 hasConceptScore W2083058438C159110408 @default.
• W2083058438 hasConceptScore W2083058438C160735492 @default.
• W2083058438 hasConceptScore W2083058438C17744445 @default.
• W2083058438 hasConceptScore W2083058438C199539241 @default.
• W2083058438 hasConceptScore W2083058438C2776534028 @default.
• W2083058438 hasConceptScore W2083058438C71924100 @default.
• W2083058438 hasIssue "2" @default.
• W2083058438 hasLocation W20830584381 @default.
• W2083058438 hasOpenAccess W2083058438 @default.
• W2083058438 hasPrimaryLocation W20830584381 @default.
• W2083058438 hasRelatedWork W2059128409 @default.
• W2083058438 hasRelatedWork W2095552983 @default.
• W2083058438 hasRelatedWork W2416843187 @default.
• W2083058438 hasRelatedWork W2748952813 @default.
• W2083058438 hasRelatedWork W2899084033 @default.
• W2083058438 hasRelatedWork W2992952107 @default.
• W2083058438 hasRelatedWork W3031052312 @default.
• W2083058438 hasRelatedWork W3131135199 @default.
• W2083058438 hasRelatedWork W4298173943 @default.
• W2083058438 hasRelatedWork W3172308530 @default.
• W2083058438 hasVolume "16" @default.
• W2083058438 isParatext "false" @default.
• W2083058438 isRetracted "false" @default.
• W2083058438 magId "2083058438" @default.
• W2083058438 workType "article" @default.