Executive Summary, Quality Council Report
In 2009, the Legislature and then Governor Lynch of The State of New Hampshire (NH) established the Quality Council for those served by the NH Developmental Services System. The Quality Council grew out of recommendations contained in SB 138 report, Quality Improvement Committee Report, released in 2008. The mission of the Quality Council is to “Provide leadership and recommendations for consistent, systemic review and improvement of the developmental disability and acquired brain disorder services provided within New Hampshire’s Developmental Services System.”
When it was clear that the State of NH would be moving towards Commercial Managed Care for its Long-Term Services and Supports (LTSS) the Quality Council established a subcommittee to study this topic. In the spring of 2014, the Quality Council was asked by the Department of Health and Human Services (DHHS) to make systemic recommendations regarding the transition to Commercial Managed Care.
The full report formally adopted by the Quality Council on January 20, 2015 includes:
• Important aspects of the current NH Developmental Services System that must be maintained and included in a Commercial Managed Care environment; and
• Additional “must haves” for inclusion in any systemic changes are related to either:
o Systemic Quality,
o Individual Experience of Quality of Life, or
o Caregiver Quality of Life.
The Managed Care Organizations (MCOs) delivering LTSS in NH shall be required to possess and demonstrate financing, administrative, programmatic, and care coordination capacity and infrastructures to enable it to comply with the terms of the contract.
The final report covers 20 topic areas and took nine months to complete. It is reflective of where NH is today and while the managed care system continues to evolve, the Quality Council may modify these initial recommendations. This list should not be considered exclusive and some subjects may have been inadvertently omitted. The Quality Council also researched how other states handled the transition to managed care for individuals with disabilities and incorporated some of the best practices into its recommendations. Some of these recommendations largely incorporate and summarize the following resources from the Centers for Medicare & Medicaid Services (CMS) and the National Senior Citizens Law Center (NSCLC):
1. Advocate’s Library of Managed Long Term Services and Supports Contract Provisions, NSCLC; available at:http://www.nsclc.org/index.php/ltss-contracts-index-appeals-notices/
2. Long-Term Services and Supports: Beneficiary Protections in a Managed Care Environment, June 2012, Special Report by NSCLC and Disability Rights Education & Defense Fund, available at http://dualsdemoadvocacy.org/wp-content/uploads/2012/06/Special-Report-LTSS-June-2012-Final.pdf
3. Medicaid Managed Long-Term Services and Supports: A Review and Analysis of Recent CMS Waiver Approvals in New Jersey and New York, March 2013, Special Report by NSCLC, available at: http://www.nsclc.org/wp-content/uploads/2013/03/MLTSS-NY-NJ-Final-030113.pdf
4. Transitioning Long Term Services and Supports Providers Into Managed Care Programs, May 2013, Brian Burwell & Jessica Kasten, Prepared by Truven Health Analytics for CMS, available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/Transitioning-LTSS-.pdf
5. Summary – Essential Elements of Managed Long Term Services and Supports Programs, CMS, available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/MLTSS-Summary-Elements.pdf
6. Guidance to States using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs, May 20, 2013, available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf
7. Summary of CMS Guidance on Managed Long-Term Services and Supports, May 2013, NSCLC, available at: http://www.nsclc.org/wp-content/uploads/2013/05/MLTSS-Guidance-052313.pdf
In addition to the topic areas, there are considerations for DHHS to put into place prior to and during the implementation of Managed Care in NH. The 20 topic areas included in the final report are as follows:
2. Continuity of Care
3. Individualized Plans of Care
5. Care Coordination/Service Coordination
7. Coordination of Medicare Services for Dually Eligible Enrollees and Private Insurance