Medicaid Managed Care - U.S. Senate Special Committee on Aging

20
r_
06/23/1997 16: 03 7836845968 PA 02
National;
Mental Health
s AssociationiM Preddet ad CEO, Mirin Nt Pae=
1021 P eI,,rS,. Alunddri VA 22314-2971 Plane 703/684-7722 F. 703/16584-5968 Wnn -hnrJ/wwwoddoet/deonlinnnb.
AL GUIDA' 5 TALKING POINTS
POR
SENATE. AGING COMWITTNE'S .
PEOPLEVWITE SPECIAL NEEDS PORUM
General Theme: <strong>Managed</strong> care has a long -- and largely
successful -- track record in providing acute care medical services
to an essentially healthy enrollment base. However, as these plans
compete to secure public sector <strong>Medicaid</strong> contracts involving direct
service delivery -to people with disabilities. and children with
complex medical conditions,.a number of questions emerge:
i.) Do medical necessity criteria need to be adjusted?
Today, <strong>Medicaid</strong> finances an array. of services that are
designed to: (i) sustain and:slowly improve the functional capacity
of people with disabilities and Iii) assist disabled children in
attaining and m4intaiunknI developmental milestones.
Specifically, <strong>Medicaid</strong> pays for developmental services like
occpuational therapy, physical therapy and speech language
pathology for children with mental retardation, cerebral palsy,
cystic- fibrosis and.autism. : In most cases, these services are
furnished over a period of years and produce relatively slow
improvements in functional capability over time.-
NM3A believes that public sector medical necessity criteria
must be modified so that these long-term care services will
continue to be provided..
2.) Do case management definitions need to be adjusted?
Public sector and private sector 'case management" are two
very different creatures. For example, in most cases, HMOs provide
assistance to enrollees in navigating their acute care medical
network. On the other hand, "intensive case management --_
financed through <strong>Medicaid</strong> at state option -- facilitates access for
people with disabilities to an array of community services,
rehabilitation programs, supported housing opporunties, and peer
support groups.
It seems clear that. these two world views need to be
reconciled as <strong>Medicaid</strong> managed care movements forward.
3.) What services will be financed by .MOs that win <strong>Medicaid</strong>
contracts?