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Could Pennsylvania’s Long Term Care System Soon be Administered by Managed Care Organizations?

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Pennsylvania’s Department of Human Services (DHS) and Department of Aging (PDA) have been seeking comments on a “Discussion Document” setting forth their intent to administer long term care services by Managed Care Organizations (MCOs). The plan is to start accepting bids by MCOs by the fall of 2015. The proposal is called the Managed Long Term Services and Supports (MLTSS). The stated goal of this change is to increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes while receiving long term care services.

Public hearings have been held throughout June 2015 to provide some basic information about the program and solicit input by those that would be affected by the change. The scope of the program affects not only the elderly in nursing homes and Pennsylvania’s Aging Waiver Program but also those individuals who are; a) dually eligible for Medicaid and Medicare; b) those in most of Pennsylvania’s Waiver Programs and, c) those in the Act 150 Program (Non-Medicaid).

Like Pennsylvania’s current Medicaid benefits under the HealthyChoices Program, Medicaid long term care coverage under Managed Care Organizations would likely divide the state into regions covered by networks of MCO’s that include not only medical providers (hospitals, doctors, labs, etc.) but also long term care providers (nursing homes along with home and community based services). This is very different from the current model where the Waiver system and nursing homes operate separately from the HealthyChoices managed care system.

The tone of the Discussion Document suggests that the move to a managed care system will happen. Motivated by a desire to improve the coordination of care, access to services and the ability to control costs, movement to managed care programs has become a trend across the country. To date, 22 states have implemented some form of a managed care program.

The proposal follows many of the recommendations of the Long Term Care Commission report issued last year. The design of the program should offer a person-centered approach with more choices for services and providers.  The services package that the managed care organizations must offer will include not only Medicaid services, but also Medicare and additional support services to target populations. Preventative services will be integrated into the system.

Like so many managed care organizations, there will be a services coordinator who will work with the participants to monitor the participant’s care and quality of services they are receiving. Performance based payment incentives and a focus on quality and outcomes are part of the proposal.

The deadline for submission of comments to Discussion Paper is July 15, 2015. The proposed date for implementation of the program is spread out over a four (4) year period, ending in 2019.