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Managed Care Archive

September 2012
State Innovation Model (SIM)
September 20, 2012New Hampshire State Department of Health and Human Services is holding a stakeholder meeting to develop an innovative services delivery and payment model for health care, including long term care. The federal Center for Medicare and Medicaid Innovation has issued an announcement for State Innovation Models (SIM): Funding for Model Design. CMS is seeking innovative models that have the potential to maintain or improve quality of care for beneficiaries while lowering costs for Medicare and Medicaid. For more information…DHHS has taken a leadership role in applying for the CMS State Innovations Model Grant. The SIM grant presentation is on the DHHS website For more information…

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State of NH is First State to Receive the Balancing Incentive Program’s federal grant

September 2012

The Balancing Incentive Program (BIP) authorized a grant to New Hampshire to increase access to non-institutional long-term services and supports. The Balancing Incentive Program will help New Hampshire transform our long-term care systems by: lowering costs through improved systems; performance and efficiency; creating tools to help consumers with care planning and assessment; and improving quality measurement and oversight. For more information…

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Balancing Incentive Program: Strengthening Medicaid Community-Based Long-Term Services and Supports

The states and the federal government recognize the increasing demand for providing long-term services and supports (LTSS) in the community to promote a higher quality of life for Medicaid beneficiaries in the setting of their choice. The Balancing Incentive Program was created by the Affordable Care Act (ACA) to support this goal. For more information…

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CSNI Sends Letter to the Centers of Medicare and
Medicaid Services about Managed Care Step 2

On September 14, 2012, Richard Crocker, Executive Director of CSNI sent a letter to Cindy Mann the Director of Centers of Medicare and Medicaid Services (CMS). CMS is the federal agency that administers the Medicare program and works in partnerships with state governments to administer Medicaid. CMS has to approve the state’s plan to move forward with Step 1 and Step 2 of managed care. According to the letter, “from the perspective of CSNI, the Area Agency system, and families, NH’s managed care initiative is so flawed in so many ways, that we request that CMS reject the inclusion of Step 2 services for persons with developmental disabilities and acquired brain disorders as part of the NH Medicaid managed care contract. We truly believe that if NH continues to go down the path of Step 2 managed care as it has thus far, that there is no doubt that the safety, well-being, health and quality of life of individuals with developmental disabilities and acquired brain disorders and their families will be severely impaired.” For more information…

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Structuring New Service Delivery Models for Individuals with Developmental Disabilities

The system of services and supports available to individuals with intellectual and developmental disabilities (I/DD) seems caught between the past and future. For more information…

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What is the current status of Medicaid Managed Care (MMC)? Summer/Fall 2012

The US federal agency which administers Medicare and Medicaid or the Centers for Medicare & Medicaid Services (CMS) is reviewing or will be reviewing the following items:

State Plan Amendment (SPA)

Capitated rates paid to the Managed care Organizations (MCO’s)

MMC Contract between the state of NH and the MCO’s

· All three of the above items must be approved by CMS.

The MCO’s are attempting to contract with NH medical and behavioral health providers to create an “adequate” healthcare network. Each MCO network must be approved by DHHS and CMS.

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He-W 506 Medicaid Managed Care – Response to Medical Care Advisory Committee (MCAC)

The Final Proposal for He-W 506 Medicaid Managed Care is currently being finalized. The Final Proposal will be filed by Thursday, September 6, 2012 and will be reviewed by the Joint Legislative Committee on Administrative Rules (JLCAR) on September 20, 2012. It will also be posted on the DHHS’s Administrative Rules Unit web site (http://www.dhhs.nh.gov/oos/aru/comment.htm). Here is the DHHS’s response to the MCAC subcommittee’s comments on the rule. DHHS staff will be available at the MCAC meeting on September 10, 2012 to discuss the Final Proposal and the DHHS’s response, and to receive any further comment on the rule. For more information…

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Monthly Archived Articles

August 2012