What’s Happening in
Managed Care?
2007 Legislature considers changes for people with disabilities
by Elissa Meyer
Managed-care changes are in
the works at the state capital. As Minnesota legislators consider
expanding enrollment in prepaid health plans for persons with disabilities,
several issues have come to the forefront this session. Among several
key changes, proposed legislation would strengthen the ombudsman
services.
Enhancing the Role of the
Ombudsman
The Ombudsman Office (for
state managed health care) needs to grow to meet a growing population.
The office helps people enrolled in health plans to solve problems
with access, service and billing. It also provides information about
the grievance and appeal processes available through both the health
plan and the state. As more persons with disabilities enroll in prepaid
health plans, the role of the Ombudsman will become increasingly
important. “We
simply need trained ombudsmen staff to assist persons with disabilities
who voluntarily choose to join a managed care plan. This is an
expanded population so we need an expansion of the ombudsmen’s
office for managed care,” said Anne Henry, attorney with
the Disability Law Center.
Proposed legislation
would raise enrollee’s awareness of the
ombudsman’s role and their own rights. It would require local
agencies to provide annual information to health plan enrollees about
the role of the Ombudsman and their right to have complaints resolved.
Under current law, this information is provided only once—at
the time of enrollment. The bill also requests funding for increases
to Ombudsman staff; the office would hire more people who are specifically
trained and experienced in providing assistance to persons with disabilities.
Further, the proposal would give annual reports to legislators so
they can assess how well the prepaid health plans are working. The
Ombudsman Office would have to document their activities by program,
age and eligibility type. This information would have to include
the number of persons assisted, the types of problems encountered,
and any actions taken, including appeals and outcomes for enrollees.
Based on these findings, the report would make recommendations for
changes to managed-care contacts, grievance and appeal processes,
or other changes for general improvement of managed-care services.
These enhanced reporting requirements will enable policy makers and
advocates to better understand whether prepaid health plans can adequately
meet the diverse and complex needs of persons with disabilities.
Delaying the Expansion of
Minnesota Disability Health Options
Under the new legislation, the Minnesota Disability Health Options
(MnDHO) would not expand beyond the seven-county metro till 2009.
The purpose of the delay is to allow the Minnesota Department of
Human Services, with input from consumers, advocates, and health
plans, time to further develop an expansion plan and more clearly
define the requirements for quality disability care coordination.
MnDHO is a voluntary
managed-care option for Medicaid-eligible adults (age 18-64) who
have a certified primary physical disability. MnDHO operates through
a partnership between UCare Minnesota, a health plan, and AXIS
Healthcare, a disability care coordination organization. MnDHO
covers the full range of Medicaid, Medicare and home and community-based
services benefits. AXIS Healthcare provides each MnDHO enrollee with
a team of disability specialists to help coordinate their health-care,
housing, transportation and other social service needs. “AXIS
has made my life so much better. My nurse knows all of my health
concerns. Since joining AXIS, I’ve been healthier, happier
and more independent,” David Adank, MnDHO member.
The MnDHO program as it exists now will continue to operate in Hennepin,
Ramsey, Anoka, Dakota, Scott, Carver, Washington counties despite
the delay.
New Options for Basic Services
Beginning in January 2008, persons with disabilities would also
have new options for receiving basic health-care services through
a prepaid health plan. Basic services do not include any long-term
or home and community-based services. As additional choices become
available, it is important to be aware of the differences among plans
and types of services offered. These new programs remain voluntary;
Medicaid fee-for-service will continue to be an option for healthcare
service delivery for persons with disabilities. ![]()
Take Action!
If you feel strongly about health care for people with disabilities
in Minnesota, now is the time to get involved.
• Find out who represents you: Go to www.leg.state.mn.us and
click on “Who Represents Me.” You can also call 651-296-2146,
TTY-651-296-9896, for help in identifying your representative and
senator.
• Talk to your
legislators: It is important that they hear from you. Your stories,
input, and experiences are the most valuable pieces of information
legislators can have before making decisions that impact your health-care
options.
• Participate in
Advocacy Day: Tuesday April 3, 2007. Visit www.courage.org for
more information.
• Join the disability
community for a rally at the capitol: The Minnesota Consortium
for Citizens with Disabilities Rally at the Rotunda, Thursday April
12, 2007. For more information visit www.mnccd.org ![]()
