Long-Term Services and Supports:
Beneficiary Protections in a Managed Care Environment
A toolkit for advocates on LTSS-specific beneficiary protections developed in partnership with the Disability Rights Education and Defense Fund (DREDF).
Managed Care Context | Managed Care Plan Infrastructure | HCBS Benefit Packages | Provider Choice and Access | Care Continuity | Person Centered Care Planning | Self Direction | Assessments | Care Transitions | Appeals and Grievances | Ombudsman | Meaningful Systemic Stakeholder Involvement | Civil Rights | Financing | State and Federal Oversight and Monitoring | Quality Measurements, Data and Evaluation
A growing number of states are proposing to place the responsibility for providing long-term services and supports (LTSS) to seniors and people with disabilities under managed care organizations (MCOs). These proposals offer both significant risk, and considerable opportunity. Strong beneficiary protections specific to the delivery of LTSS must be incorporated to ensure that states and MCOs develop models that best supports independence and the ability of beneficiaries to remain in or return to community settings
This toolkit provides ideas for LTSS beneficiary protection that state advocates can use to push for strong protections in managed LTSS programs. To be successful any MCO taking on responsibility for LTSS will need to possess or quickly acquire and incorporate solid and proven LTSS policy and operational components. From the beginning, and at all levels, an MCO will need to work in very close partnership with beneficiaries and advocates to meet very non-homogenous needs.
The toolkit looks at LTSS consumer protections and opportunities in 15 areas. Each area provides a general summary of its importance and how it fits within LTSS, and then several specific ideas that could be incorporated into developing models. The ideas for protections and opportunities are drawn from current managed LTSS programs, state proposals, advocates recommendations and other sources.
Not all specific protections and opportunities may be appropriate or feasible in any particular state model. The items listed are meant to stimulate thinking among advocates about what protections and opportunities would most fit the unique circumstances in their states. As more states develop managed LTSS programs, we hope to update and expand this tool. (Download PDF version, updated June 2012).