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Supporting the Continuum of Care for Serious Illness in Medicaid Managed Care October 25, 2021 / by Salom Teshale, Kitty Purington, Wendy Fox-Grage, and Mia Antezzo. Comprehensive care coordination. billion on chronic obstructive pulmonary disease (COPD) per year. Assessment and management of pain and other symptoms.
rebalancing spending to improve access to home and community-based services, improving caretransitions, or encouraging greater care coordination) Innovative oversight approaches for Medicare/Medicaid integrated models What’s In It for States?
States are increasingly turning to capitated Medicaid managed care programs to deliver long-term services and supports (LTSS) to individuals with complex needs. California does cover skilled nursing facility care in its MLTSS program, but most personal care services (in-home supportive services) are provided under FFS.
More states are contracting with managed care organizations (MCO) to provide Medicaid long-term services and supports (LTSS). How do we know if MCOs are delivering equitable, high-quality care to people receiving LTSS? CareTransitions: Individuals receiving LTSS experience smooth and safe transitions between care settings.
How State Medicaid Programs Serve Children and Youth in Foster Care May 17, 2022 / Veronnica Thompson. Children and youth in foster care (CYFC) often benefit from targeted services and supports. Yet, many receive fragmented or limited access to care, contributing to higher rates of unmet health needs. [1]
The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs ACO AccountableCare Organizations. CBCM Community Based Care Management Program. MHP Medicaid Health Plans.
On October 20, 2021, the Centers for Medicare and Medicaid (“ CMS ”) Innovation Center (“ Innovation Center ”) published a white paper detailing its vision for the next ten years: a health system that achieves equitable outcomes through high quality, affordable, person-centered care. Strategic Objective 1: Drive AccountableCare.
Patrick Blair, formerly of Bayada Home Health Care, has been named president and CEO by InnovAge’s board of directors. The appointment comes after reports that Colorado’s Department of Health Care Policy and Financing and the U.S. Centers for Medicare and Medicaid Services (CMS) stopped reimbursing InnovAge for new clients.
CHWs are key to engagement, care coordination, and increasing access to clinical and support services for Medicaid enrollees from their communities. As such, states increasingly are pursuing Medicaid reimbursement options as part of a comprehensive CHW service financing approach, which is currently reliant on expiring grant programs.
The shift to value-based care. Connecting training with outcomes serves patients and staff, but the shift to value-based care means attention to outcomes is imperative as home-based caretransitions to rewarding providers for the quality of the care they deliver.
The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.
As states are seeking sustainable financing models and partnerships that offer continued support for the CHW services beyond the COVID-19 pandemic, many are exploring Medicaid reimbursement models. APMs can apply to a specific clinical condition, a care episode, or a population.” What is an Alternative Payment Model?
Effective communication during caretransitions, along with proper medication reconciliation, is vital for preventing readmissions and improving overall patient outcomes. Recognizing these characteristics allows caregivers to craft individualized plans accounting for each patients particular risks and requirements.
Value-based care, a model that rewards better patient health outcomes, has experienced a surge in interest amid heightened consumer awareness and among payers seeking to lower costs and stabilize reimbursement. The acceleration of the value-based caretransition isn’t slowing; the good news is, it’s not too late to get started.
Medicaid Reimbursement. Medicaid Reimbursement. Alabama does not reimburse for CHW services through its Medicaid program. Alaska Medicaid reimburses for CHW services through MCOs as authorized under the state plan. Arizona does not currently reimburse for CHW services through its Medicaid program.
Shared Plan of Care. Care Coordination Workforce. CareTransitions. public health, Medicaid, mental health) and other stakeholders (e.g., On the other hand, a health plan may use the guide to implement a high-quality screening and assessment process through primary care providers. State Medicaid agencies.
Equipped with the right tools, providers can make the appropriate post-acute care decision for their patients to mitigate readmission risk and reduce potential post-acute care spending. As touched on above, post-acute care delivered in the SNF setting accounts for a significant portion of Medicare fee-for-service costs.
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