Changes Ahead in Managed
Care
by Anne Henry, MN Disability
Law Center
The 2006 Minnesota Legislature
adopted several significant changes for persons with disabilities
who use Medical Assistance health coverage. The legislation, developed
by disability advocates and authored by Representative Finstad and
Senator Lourey, sets a path for further development of managed care
options for persons with disabilities in Minnesota. The most significant
of the changes affect persons who are eligible for both Medicare
and Medical Assistance beginning in January 2007.
Background
In Minnesota, there are approximately 95,000 persons eligible for
Medicaid (Medical Assistance) due to disability. Two of the three
separate eligibility groups who qualify for Medical Assistance (MA),
families with children and the elderly, are now required to join
a managed care plan, about 286,000 persons. Efforts are underway
to include persons with disabilities in managed care under MA. Key
issues include whether participation in a managed care plan is voluntary
or mandatory and whether the managed care health plan will include
continuing or long-term care services in addition to basic health
care.
Of the 95,000 persons
eligible for MA due to disability, over 40 percent are eligible
for Medicare coverage as well. Persons with both Medicaid and Medicare
are called “dual eligibles.”
Currently, there are at least three separate types of managed care
models for persons with disabilities in Minnesota; one is now operating
and two are under development. The three types of managed care models
in Minnesota include:
Minnesota Disability Health Option (MnDHO)
The Minnesota Disability Health Option includes Medicaid and Medicare
benefits as well as both basic health care and continuing or long-term
care services for persons with disabilities. Two separate projects
operate under the MnDHO authority: AXIS/UCARE in the metro area is
serving persons with physical disabilities, 63 percent of whom also
have a mental health diagnoses and Partners Choice Network for persons
with developmental disabilities connected with Mount Olivet Rolling
Acres in Carver, Scott and Hennepin Counties. The MnDHO program is
patterned after the Minnesota Senior Health Option, which is available
across Minnesota. The MnDHO program is required to be voluntary so
that a person may choose to join or leave each month.
Medical Assistance Managed
Care
Medical Assistance managed care, known as prepaid Medical Assistance
(PMAP), does not cover persons with disabilities. PMAP covers low-income
families with children and seniors over 65.
Currently, there is a legislatively established DHS stakeholder
group working to develop a plan for Medical Assistance managed care
options for persons with disabilities for implementation by January
2007. This stakeholder group, led by Assistant Commissioner Brian
Osberg, involves only the Medical Assistance program and is limited
to basic health care.
Medicare Special Needs Plans
Medicare is a federal
program funded solely with federal funds and enrollee co-payments,
deductibles and cost sharing. Several years ago, federal legislation
established Medicare special needs plans that allow health plans
to focus on one of several populations of special needs individuals
and offer managed care plans for Medicare covered services. Minnesota
currently has nine Medicare special needs plans, called SNPS (pronounced “snips”)
for seniors and two plans specializing in services for persons
with disabilities. The two Medicare SNPS for persons with disabilities
are AXIS/UCARE in the metro area and AbilityCare, which is part
of South Country Health Alliance in south central Minnesota.
With at least three
separate managed care efforts underway and the governor’s
legislative proposal for significant mental health changes, advocates
decided to work for legislation to both set some parameters for
further managed care development and establish a stakeholder process.
The new legislation includes several significant provisions which
affect the future development of managed care for persons with
disabilities using MA health coverage in Minnesota.
2006 Changes
Medicare SNP + MA Basic Care
The most significant change allows Medicare special needs plans
to offer Medical Assistance basic care services in a managed care
arrangement on a voluntary basis for persons with disabilities. Given
that there are two disability-focused Medicare SNPS now operating,
it is likely that these two plans will seek to provide MA basic care
services for voluntary enrollment during 2007. The Medicare SNP +
MA Basic Care Plan is required to be voluntary so that enrollees
may decide to join if they believe the plan will meet their needs.
If an enrollee who joins finds that the plan is not satisfactory,
the individual is free to dis-enroll.
Another very significant issue in managed care is whether continuing
care or long-term care services will be included with basic care.
The Medicare SNP + MA Basic Care excludes home and community waiver
services, case management for persons with developmental disabilities
and ICF/MR services. In addition, PCA services will only be included
to the extent determined by the commissioner after consultation with
the stakeholder group. There is concern that continuing care and
community support services are different from primary health care
services and, consequently, further consideration and analysis should
occur before including those services in a managed care health plan.
Stakeholder Group
Secondly, the legislation establishes a state-level stakeholder
group for consultation with the Commissioner of Human Services on
specifications for the Medicare SNP + MA Basic Care contract, implementation
efforts, consumer protections, quality assurance measures, data collection
and reporting and evaluation of costs, quality and results. In addition,
the legislation requires that local or regional stakeholder groups
are to be established for consultation by each health plan seeking
to contract for Medical Assistance Basic Care services for persons
with disabilities.
MnDHO Expansion
Third, the legislation
establishes provisions for the expansion of MnDHO beyond the current
two demonstration projects. Expansion of MnDHO will not occur until
January 2008. Plans for further expansion will be the subject of
consultation with the stakeholder group. MnDHO’s
two projects now include all basic care as well as all long-term
or continuing care for about 670 enrollees with disabilities in Minnesota.
The stakeholders will examine the structure and policies of the current
demonstration projects to learn about the aspects of the programs
which are important for success with persons with disabilities. A
key discussion point on MnDHO expansion will be whether and how to
include home and community waiver programs within a managed care
plan. Plans for further expansion of MnDHO will be presented to the
legislative committees by February 1, 2007.
Health Plan Data
Finally, the Department of Human Services is required by the new
legislation to report aggregate health plan data in a form which
will allow tracking of services provided, major categories of spending
and criteria for service authorization. Advocates want to assure
that data now available on health care provided to persons with disabilities
under Medical Assistance continue to be available as persons with
disabilities enroll in managed care. Because health plans will be
paid a set monthly amount per person whether services are provided
or not, advocates contend that tracking spending and health care
services provided is extremely important in order to assure that
persons with disabilities receive needed services.
In the coming weeks
and months, it is expected that the Department of Human Services
will meet with stakeholders to begin development of the Medicare
SNP + MA Basic Care coverage as well as to confer on issues regarding
the inclusion of continuing care, including personal care assistant
services in managed care plans. The legislation itself (Chapter
282, Article 20, Sections 28, 29 and 30) can be found through the
legislative Web Site www.revisor.leg.state.mn.us. Individuals
interested in more information about the stakeholder process can
contact the Consortium for Citizens with Disabilities, www.c-c-d.org or
a disability advocacy group with representation on the stakeholder
group, such as Arc Minnesota, National Multiple Sclerosis Society
Minnesota Chapter, Courage Center, National Alliance for Mental
Health, and the Governor’s Council on Developmental
Disabilities.
