Purpose-built Technology for Managed Care
Now the most relied upon long-term solutions for Government Agencies are available to Managed Care Organizations. Increasingly, states through the use of Managed Care 1915(b) waivers are turning to managed care organizations (MCOs) to administer the delivery of long-term services and supports (LTSS) to peoples with disabilities.
In its FY13 latest report, The Centers for Medicare & Medicaid Services (CMS) reported that HCBS accounted for the majority of Medicaid LTSS expenditures. Total federal and state LTSS spend was $146 billion, HCBS share was $75 billion (51.3%) a two percent increase from the previous year. This also marked the third consecutive year in which HCBS spend increased and institutional spend decreased.
Managed Care grew by 44% from $10 billion to $14.4 billion. MCO’s accounted for 9.9% of LTSS spend but due to ongoing challenges with collecting managed care data this may be a conservative estimate.
HCBS Waiver Risk Management
The maze of waivers currently in place coupled with the myriad of funding criteria poses a unique reimbursement reporting challenge for both State and MCO LTSS administered programs. Harmony for waivers is scalable to support state-wide deployments while its flexibility insures that each waiver managed, meets the programs funding reporting requirements to mitigate reimbursement denials.
The swift adoption of waivers by the states to shift to home and community-based services has also blurred the traditional organizational structure which in the past focused on a specific group rather than a ubiquitous view across the entire LTSS spectrum of peoples with disabilities. The challenge for LTSS payers to stay ahead of the curve is to develop longitudinal metrics to measure outcomes in order to discern which programs yield the best results.