The National Disability Leadership Alliance (NDLA)–a coalition of 14 leading disability organizations, including United Spinal Association, has developed an advocacy tool that highlights key principles for providing coordinated quality health care in Medicaid managed care programs for people living with significant disabilities.
As Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs grapple with how best to apply managed care to our higher risk, higher cost population, United Spinal and the NDLA hope this new set of principles will provide utility to these payers, as well as to beneficiaries, their advocates and other stakeholders who must be actively involved in all aspects of program development, evaluation, refinement and innovation.
Such stakeholder engagement will help to ensure that beneficiaries will continue to receive necessary services and supports while reinforcing their capacity to work and enjoy productive, quality lives in their communities.
Among the 16 principles are emphasizing patient choice; advancing home- and community-based services and supports; ensuring access to durable medical equipment and assistive technology; maintaining Medicaid buy-option for low income workers; and supporting family caregivers.
The principles are not intended to oppose managed care applications. They are offered in an effort to ensure that managed care pursuits achieve their intended goals by being fair and deliberate–such as gaining experience and knowledge in stages, while guaranteeing necessary patient protections, care delivery features, performance and quality requisites and emphasis on community integration. With attention to these principles, United Spinal believes federal and state governments will be provided their best chance of achieving lower costs while improving the coordination, continuity and quality of care.
The federal government is currently examining managed care approaches with states in demonstration projects being applied to those dually eligible for both Medicare and Medicaid who account for only 15 percent of Medicaid enrollees but about 40 percent of all Medicaid spending. This population includes 3.5 million beneficiaries with disabilities under the age of 65.
United Spinal and the NDLA urges that the new principles be applied fully by both the Centers for Medicare and Medicaid Services (CMS) and individual state Medicaid programs as they examine ways to broaden the application of managed care to beneficiaries with significant disabilities in the interest of containing spiraling health care costs.
Joseph Isaacs, United Spinal’s VP of Public Policy explains the principles ensure that the transition by states to Medicaid managed care for beneficiaries with significant disabilities is undertaken appropriately.
“Appropriately means, among other things, incrementally and fairly, with consumer planning and self-direction; stakeholder engagement in all aspects of the program; emphasis on community integration and employability; assurances of patient protections, fair appeals processes and nondiscriminatory practices; and access to an adequate provider network and to a full continuum of quality care and long-term services and supports,” says Isaacs.
“United Spinal took the lead on creating this tool with input from NDLA Health/Medicaid Working Group. I think that it will provide considerable utility to our grassroots efforts across the country in view of the stampede by states to managed care for higher cost, higher risk beneficiaries,” Isaacs adds.