1. States are Shifting More LTSS Programs to Managed Care
Key Finding #1
States are Shifting More LTSS Programs to Managed Care
Long-term services and support generally cover patients with complex disabilities, mental and behavioral health conditions, and complex chronic conditions. States are shifting more LTSS programs to managed care through state plan amendments and 1915/1115 waivers that enable unique managed care arrangements.
The complex conditions of an eligible MLTSS patient would typically not be part of the MCO service or capitation rate. It is difficult to project spending for these complex cases, which makes it difficult for managed care to accept the risk.
Failure of a proper spending forecast would often lead to inadequate services for the patient.
There is a recent trend toward introducing risk-adjusted capitation rates for these patients. States are now moving forward with additional MCO contracting in these high-risk areas.
Savings resulting from the increased quality of care can be offset by providing additional services to the beneficiary.
Caregivers can also be more proactive approach on medication adherence, reducing sickness and/or hospital admissions.