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Managed Medicaid presentation slides
- 1. Managed Medicaid: Our New Paradigm Patsy Tschudy, RN, CCM, Director of Managed Care Cantex Continuing Care Network Paul Gerharter, RN, C, Director, Post-Acute Services Touchstone Communities …
- 2. Industry History • Medicare 1965 • Medicare HMO’s 1980s • Hospice 1982 • DRGs 1983 • TILEs 1989 • PPS 1998 • Harris County Star Plus Demonstration
- 3. • Medicare PDP Programs – 2006 • Affordable Care Act - 2010 • Medicaid RUG transition - 2008-2010 Industry History
- 4. • When??? – March 2015 • Why??? – Increasing Lifespan – Increasing Beneficiaries – Workforce Decreasing Managed Medicaid
- 5. • Passed – 83rd Session • Medicaid HMO • Impacts 60K+ Facility Residents • 19 States Preceded Texas • HHSC – Standards & Regulations Senate Bill -7
- 6. • Goal – Quality Improvement • ↑ Access • ↑ Outcomes • ↓ Cost • ↓ Readmissions • ↓ Preventable Events Senate Bill -7
- 7. • Eligibility – State Determines • 5 MCOs – Texas – UHC – Amerigroup – HealthSpring – Molina – Superior Senate Bill -7
- 8. • MCOs - Distribute Enrollment Packets • Plans - Provide Care Coordinator • No Admission Pre-Certification • 100% Medicaid RUGs Reimbursement • Pay For Performance Senate Bill -7
- 9. What Does This Mean To Referral Sources?? • Education: – Marketing – Discharge Planners – Physicians
- 10. What Does This Mean To Me? • Understanding – Change – Appropriate Placement – Pre-Certification Requirements
- 11. • Prepare List – Facility Providers • Be Available - MCO Site Visits • Coordinate MCO Facility Orientation • Host Resident Council • Host Open House – Families • Review Admission Process • Review Documentation What Do I Need To Do Now?
- 12. • Collaboration With Payors • Care Coordinator Involvement – Care Planning & Family Meetings – Discharge Planning • Higher Acuity – Beds To Fill The Future?
- 13. • Current Clinical Skills • Needed Resources – IV Certification – TPN – 24/7 RNs – Complex Wounds – Resp. Therapy – Pulmonary Unit - Vents The Future?
- 14. Dual Demonstration Project • Targets Traditional Medicare Beneficiaries and Medicaid Recipients • Effective 3-1-15 • Passive Enrollment to Medicare HMO over 6 Months • Goal: ↑ Care Coordination