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Commissioner Toumpas gave an update to the Governor and Council this morning on two issues:

Posted: February 18, 2014

Medicaid Managed Care

There was a managed care contract amendment before the Council (which was approved). The Commissioner said the purpose of the amendment was to allow DHHS to begin paying the MCO’s (because the contract includes a “90 day lag.”) The contract amendment actually reduces the amount paid to the MCO’s (from the original contract) because of the delay with managed care.

The Commissioner said the transition to managed care has three main challenges:

  1. Transportation
  2. Prior authorization issues
  3. Administrative burdens for providers

To address the above concerns, the department’s “Cross Functional” team is meeting daily.

The department is also going to convene a “Lean Process” group to review Medicaid managed care issues. One of the goals of the group will be to streamline paperwork. The department needs to determine if the issues raised are isolated incidents or systematic problems. The Commissioner said he believes most are systematic problems.

On Monday, the Commissioner met with two MCO’s to discuss the concerns raised at last Thursday’s managed care commission meeting. The Commissioner sent the MCO’s the two articles in the Laconia Newspapers and has asked the MCO’s to create a “corrective action plan.”

The Commissioner said that one item that came from the commission meeting was that Medicaid recipients “didn’t know they could call the department with their concerns” he is happy that the two articles provided that information to the public.

Step 3 Update

The Commissioner has been meeting with Senate leadership and the Governor and there is an agreement “in principal” to expand healthcare under the ACA. The Commissioner that this will be a “very different model.” That was it on step 3.

Step 2 Update

There are apparently now “4 Tracks” to step 2.

Finally, the Commissioner strongly implied that step 2 will not begin on December 1, 2014.

Councilor Sununu asked several questions including, whether or not “Stakeholders” will be involved with the planning of step 2 and if the MCO’s would be upset if step 2 was delayed. Answer: Stakeholders will be involved, Toumpas suggested that the Councilor ask the MCO’s on their feelings about delaying step 2.

At this point the Governor jumped in and said the MCO’s expected step 3 to already be taking place and that step 2 cannot be rushed. She also said stakeholders need to be involved and we need to preserve the network of involvement and control already present in the DD system for long term care while at the same time using the coordination the MCO’s offer. Hassan said “We need to keep the positives that both the MCO’s and the Area Agencies offer” She concluded by again saying we cannot do step 2 until it is fully ready.

Senior Nutrition and Transportation RFP

The Commissioner was asked by three Councilors (Pappas, Van Ostern and Pignatelli) about the many concerns they hearing from the human service agencies who provide meals and transportation to NH seniors.

The Commissioner said he will respond in writing following the meeting, however he made the following oral remarks:

The current system is fragmented and we need to start looking at the “whole person.” DHHS has a whole person orientation and agencies need to begin to adopt this orientation. The initial RFP was pulled because of the concerns raised, there was disconnect and the providers didn’t respond to the whole person approach. The agencies need to look at different ways to integrate the whole person. DHHS is looking at new ways to reimburse providers. The current system is unfair to rural providers and favors more urban agencies. The current “one size fits all” reimbursement doesn’t work. The Commissioner did say that he is not looking to reduce agency funding but did concede that there will be winners and losers in the new reimbursement formula.

Having said all this, the Commissioner conceded that the current RFP’s approach may not work and he is discussing with his team keeping the current situation in place. He strongly hinted the status quo might continue, because we need to step back and do this planning outside of an RFP process. Toumpas said we need a more thoughtful approach to this issue. He concluded by saying “We need to look at this issue in a more long term view and I don’t want to put the agencies at risk.”

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