“Bipartisan effort probes federal oversight of Medicaid LTSS programs,” by Lois A. Bowers, McKnight’s Senior Living

“Sept. 13 is the deadline Sens. Chuck Grassley (R-IA) and Bob Casey (D-PA) on Friday gave to Centers for Medicare & Medicaid Administrator Seema Verma and the directors of the eight external quality review organizations that audit Medicaid managed care organizations to answer questions about access and quality of states’ long-term services and supports programs. … Increasingly, the senators noted, older adults are receiving LTSS from MCOs through home- and community-based services. The number of states implementing managed care for beneficiaries needing LTSS increased from eight in 2004 to 27 in 2017, they said.”

LTC Comment (from Stephen A. Moses, President, Center for Long-Term Care Reform):

Here’s how I describe the problem in a new paper: “The latest attempt by Medicaid to mitigate the rising cost of long-term care is to modify the reimbursement system. Huge changes in how the government pays for post-acute and long-term care are underway and about to revolutionize long-term care service delivery. The transformation to ‘managed care,’ whereby state Medicaid programs turn over responsibility for providing and paying for long-term care to the highest bidders, has long been sweeping the country. Most long-term care will still be provided by nursing homes and home care companies, but now a new middle-man, the managed care company, is coming between the payer (Medicaid) and the provider, which already stand between the patient and access to quality care.” For more on the related problems of “value-based reimbursement,” bundling, etc., stay tuned.