State slows managed care, yet again
By: Chris Dornin, special to the New Hampshire Challenge
Everyone in the crowded room, aides to Gov. Maggie Hassan, healthcare planners, DD parents, lawmakers and leaders from nursing homes, head injury programs, assisted living centers, area agencies, managed care companies, hospitals, HMOs and mental health centers applauded for 30 seconds when Commissioner Nick Toumpas of Health and Human Services announced the latest hold on Medicaid managed care.
“We have listened to peoples’ concerns,” Toumpas said Oct. 2 at what had been a tense meeting of the Governor’s Commission on Medicaid Managed Care. “We will go to step two (managed care for long term needs) only when we are ready.”
Some reasons to hold up the implementation
The cancelled April 1 go-live date for managed care in nursing homes and assisted living centers had worried that industry all summer. Today they get paid in large part according to their patient mix. A facility with a large share of people who are frail, non-ambulatory, incontinent and sometimes aggressive residents earns more funding for its difficult caseload.
Folks who care for senior citizens were speculating the new managed care companies might turn the whole system upside down and pay homes the same rate for all patients despite wide differences in their health status. Those institutions lose 30 cents on the dollar for Medicaid patients today, the rates are that low.
Folks in the DD community can probably substitute “area agency” for “nursing home” in guessing what is in store for them. With a huge difference...
About half the nursing home patients live in county owned facilities, which have spent years forging a litigated Medicaid cost sharing deal with the state. Might the proposed plan put profit making companies above the counties to oversee them spending their own money and take a cut of the action?
“We have listened to peoples’ concerns,” Toumpas said. “We will go to step two (managed care for long term needs) only when we are ready.”
“You have listened well,” said Mary Vallier-Kaplan, chair of the commission. “Thank you.”
“Here I am talking about step two and getting applause,” Toumpas joked. “I’m going to savor this moment.”
The Medicaid Program had just finished a four month listening campaign with 27 forums from Whitefield to Portsmouth, allowing every sector of healthcare to voice any fears, suggestions and beefs. Toumpas said more than 700 people showed up.
The commissioner said the goal is to maintain and improve the quality of care as the population ages and their medical needs grow more complex. It won’t be easy. “We have had no rate increase for years,” Toumpas said. “Whole industries are struggling. We want to make sure we do this right. We have listened. A month from now we’ll come back with a plan.”
The public will get to see at least a preliminary draft of the long-awaited blueprint for managed care at 1 p.m. on Nov. 6 in Gorham Town Hall.
“Thank you for increasing our likely audience at the meeting,” quipped commission vice chairman Donald Shumway. He’s the former head of Health and Human Services who played a large role in closing the former Laconia State School.
In step one of the process which was launched last December, more than 100,000 Medicaid subscribers chose one of the new managed care companies to pay for their hospitalizations, doctor’s visits and other treatment for acute or short term ailments. Those consumers might be enrolled in Well Sense now, Toumpas suggested, but the competing New Hampshire Healthy Families might suit them better for long term care needs and supports.
“We don’t want to do that to people,” Toumpas said.
Those two MCOs have been in a pressure cooker themselves. They have enrolled 60,000 new patients since summer, including 30,000 transferring out of Meridian, which dropped out of the New Hampshire market in July.
Toumpas said in a later interview he would never want to hurt anyone, but he also has a strong vision of what the healthcare system should look like.
“I respect the people who don’t want to do it (managed care) at all,” he said. “But it’s the law. It’s my duty to try to make it happen. I also sense the fear. It was right to create a little more breathing room.”
A sneak preview of a piece of that plan
The commission unveiled its own four-page working draft of a set of principles to assure a smooth transition to managed care, maintain quality services and supports and guide officials in writing the actual plan and the contracts to carry it out. The group decided to hone their document by email this month and discuss it again in Gorham.
The full document appears elsewhere in this issue of NH Challenge so readers can digest it and decide what it means for them. The key passage below from the draft is a suggested vision statement. It emerged from a statewide planning process funded by the feds several years ago called the State Innovation Model.
The vision for Medicaid Managed Long Term Services and Supports is for all eligible New Hampshire citizens to have access to the full array of long-term supports and services. This allows them to exercise personal choice and control, and affords them dignity and respect throughout their lives. To the greatest extent possible, each citizen should be able to make informed decisions about their aging, health, and care needs. There should be a high level of quality and accountability in everything offered and in everything provided.
The purpose is to create a dynamic and enduring community-based system of long term services and supports, so all New Hampshire citizens may live and age with respect, dignity, choice, and control through their life.
Toumpas suggested simplifying the long statement to include only principles. That change would tie his hands less in generating the department’s own plan next month. “We will be developing our own concepts,” Toumpas said. “I’m asking if you could bring it to a higher level with less detail. This has design criteria too.”
Commissioner Susan Fox worked closely with colleague Doug McNutt in writing the rough draft. “We have time to really massage this document for the November meeting,” Fox said.
Some DD parents see opportunity in managed care
Amy Girouard has a seven year old daughter with Angelman Syndrove. Her complex medical and developmental needs qualify her for services under the Katie Beckett Medicaid waiver. Unfortunately, the federal rules only pay for the girl’s aide services in the home. “I would love for her to go to after school programs or gymnastics with an aide,” Girouard said. “It’a Catch-22.”
Girourard is a consulting social worker in long term care, and she hopes managed care can eliminate the eligibility silos that are hurting her family. “It’s time for all of us to collaborate so people who need good care can get it in a person center manner,” the mother said.
Cathy Spinney is another savvy advocate for her daughter who has DD and uses a wheelchair. They’ve had a difficult experience under NH Healthy Families. The daughter needs extensive manipulation during physical therapy sessions, but the MCO has twice denied those services because the patient should be able to do them on her own at home. Spinney said this therapy is guaranteed under RSA-171, the law that created area agencies and a consumer driven DD system.
“Families find themselves fighting for things they’ve never had to fight for,” Spinney said.