Proposed managed care rule could accelerate shift away from nursing home care, official suggests

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Hospice billing patterns raise questions about care in AL facilities, a report states.
Hospice billing patterns raise questions about care in AL facilities, a report states.

Proposed regulations slated for release in early 2015 likely will affect how Medicaid managed care balances home- versus facility-based long-term care, news sources reported Wednesday.

The proposed rule should catch up to changes in how long-term care has come to be delivered, a government official said Tuesday at the Medicaid Health Plans of America conference in Washington, D.C. Barbara Edwards, director of the disabled and elderly health programs group at the Centers for Medicare & Medicaid Services, said that one of the most striking changes is the increasing importance of home- and community-based care as opposed to institutional care, according to Bloomberg BNA.

Under managed care, private-sector organizations contract with states to administer Medicaid benefits. As managed care has expanded at a rapid rate, long-term care providers have expressed anxiety over complex contracts, payment pressures and other issues.

While managed care expansion is an undeniable trend, the approach to long-term care currently varies significantly from state to state, an expert noted in a webcast Tuesday. States such as New York are “very integrated” and delivering a large proportion of long-term care through managed care organizations, but other states are on the other end of the spectrum, said Anthony J. Fiori, managing director of Manatt Health Solutions, a policy and business advisory practice of Los Angeles-based law firm and consulting group Manatt, Phelps & Phillips, LLP.

In Manatt's “Reinventing Long-Term Care” webinar, Fiori posed a question that it appears will be addressed in the new proposed rule: “What will the role of nursing homes be in managed care that is trying hard to keep people in the community?”

The forthcoming proposed rule is intended to bring Medicaid managed care regulations more in line with commercial insurance and Medicare Advantage.