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MACPAC Report Cites Problem with Medicaid Long-Term Services and Supports

Posted on Friday, June 22, 2018 7:17 PM

Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) released their June report to Congress.  This report focused on evaluating drug prices in the Medicaid Program and privacy protection for beneficiaries with substance abuse issues. 

Important to the home care industry was a chapter on the current state of managed long-term services and supports (MLTSS). Most of this chapter focused on the background of MLTSS in the Medicaid program, experiences with it from different states, a discussion on plan network adequacy, and the need for standard quality measures. The chapter concluded with a review on issues and areas within MLTSS the Commission plans to further review and study going forward.

The report from MACPAC states that as of January, 24 states have implemented an MLTSS.  The report points out numerous issues with the program.  One of the challenges is in implementing an MTLSS, even for states that have experience with a managed acute care program.  A key difference between the two programs is the complexity in the wide range of beneficiary needs in long-term care. This complexity presents a challenge in determining proper payment rates and care coordination.

“To remedy these shortcomings, a number of efforts have begun to develop quality measures more applicable to LTSS:

  • In 2015 CMS developed the Excellence of Care survey for beneficiaries that has been integrated into the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home and Community-Based Services Survey
  • Since 2015, the National Core Indicators for Aging and Disabilities Survey has been used to study both fee-for-service, and managed care programs.
  • In 2016, the National Quality Forum released a report identifying 11 areas with gaps in measurements. The report is intended to guide measurement development.
  • In an agreement with CMS, Mathematica Policy Research and the National Committee for Quality assurance are developing quality measures for MLTSS.

MACPAC expects MLTSS to continue to change and evolve with circumstances. Improving the adequacy of plan networks will be an ongoing goal, as will smoothing the re-procurement process to ensure that beneficiaries do not lose access to care while plan/provider contracts are being worked through.”

Source: NAHC Report

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