Fw: Managing Managed Care!!

[Guest guest]

FYI

Ellen

Ellen Garber Bronfeld

egskb@...

Managing Managed Care!!

Dear Advocates:

The expansion of Medicaid managed care that includes long term services and

supports for people with disabilities and older people confronts us with the

challenge of how to assure that the advances we have made in developing a

person centered, consumer directed, community based system are not diminished

or eliminated. Managed care has some positive opportunities as well as

potential for negative outcomes.

States are developing Requests for Proposals that HMO's must respond to. The

HMO's selected to administer the program then must sign a contract with the

state that outlines what they must provide , how it is delivered, how the

state will evaluate their performance and how the HMO's will be reimbursed.

Advocates should be at the table telling the state what " best practices " to

put in the RFP. In addition there must be some accountability in the managed

care contract to assure that community integration is the outcome we want.

Here are two resources for advocates:

National ADAPT negotiated Guiding Principles for Serving Individuals with

Disabilities through Medicaid Health Plans with the American Health Insurance

Program (AHIP) in 2007 . They are available at

www.adapt.org/main/ahip < http://www.adapt.org/main/ahip>

ADAPT of Texas has recently developed some proposed Community Integration

Performance Indicators (CIPI) to assess how their managed care program in

Texas (StarPlus) is doing in providing LTSS. They are available at

www.adapt.org/main/cipi < http://www.adapt.org/main/cipi>

In regard to managed care the " devil is in the details " . The details are in

the RFP's, the contracts and the rate setting.

The saying " NOTHING ABOUT US WITHOUT US " is key.

DON'T MOURN...ORGANIZE!

For an Institution Free America,

Kafkaesque

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