Medicaid Managed Care - U.S. Senate Special Committee on Aging
Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging
B-nato 438 offered and the means for providing these services can vary greatly. To promote quality and ensure that minimum standards are met requires a broad range of approaches. Although states continue to develop quality assurance mechanisms, state officials acknowledge that these are not yet comprehensive enough to assure recipient satisfaction and safety. In the three states we visited, state officials and provider agencies told us that they are still developing guidance and oversight in a number of key areas. Michigan, for example, is revising its case management standards and statewide quality assurance approaches. Rhode Island is developing a more systematic monitoring approach statewide, and Florida is continuing to implement and evaluate its independent service coordinator approach One of the greatest difficulties in developing quality mechanisms for services in alternative settings is balancing individual choice and risks." 2 Where greater choice is encouraged and risks are higher, more frequent monitoring and contingency planning need to be built into the process. Yet some professional staff and agency providers in the states we visited believe that they do not have sufficient guidance on where to draw the line between their assessment of what is appropriate for the disabled person and the individual's choice. For example, some persons with mental retardation cannot speak clearly enough to be understood by people who do not know them; cannot manage household chores, such as cooking in a safe maimer, or have no family member to perform overall supervision to keep them from danger. Yet these people express a desire to live independently, without 24-hour staff supervision. Florida, Michigan, and Rhode Island each attempt to customize supports to reduce risks for individuals who live in these situations. They may arrange for roommates, encourage frequent visits and telephone contact by neighbors and friends, enroll individuals in supervised day activities, install in-home electronic access to emergency help, and provide paid meal preparation and chore services. As this new process evolves, states and providers seek to develop a better understanding of how to manage risks and reduce them where possible. This should lead to improved guidance for balancing risks and choices for each recipient's unique circumstances "HCFA hM also eee d a,. need to belance thes imn See The Role of Medica and
Agency Comments .2-sagas 439 Determining what recipients' choices are can be difficult for a number of reasons. First many of these individuals have had little experience in making decisions and may also have difficulty in communicating. In addition, some recipients have complained that they are not being provided the fange of choices to which they should have access and that quality monitoring is too frequent or intrusive despite the changes states have introduced. However, concern has been expressed that quality assurance is not rigorous enough to reduce all health or safety risks and that the range of choices is too great for some individuals ' 3 State officials and other experts we interviewed have emphasized the need for vigilance to protect recipients and ensure their rights. They have been especially concerned with assuring quality for recipients who are unable to communicate well and for those who do not have family members to assist them The states we visited are taking special precautions to try to assure quality in these cases-such as recruiting volunteers to assist and asking recipient groups to suggest how to assure quality for this vulnerable population. However, state officials and HCFA agree that more development of quality =asurance approaches is needed. Officials from the Office of Long-Term
- Page 390 and 391: Table 1: Characteristics of <strong
- Page 392 and 393: B-27035 390 numbers of patients. In
- Page 394 and 395: B-270335 392 number of primary care
- Page 396 and 397: B-Z7Oa33 394 developed on the premi
- Page 398 and 399: States Challenged to Develop Effect
- Page 400 and 401: B-270335 398 that beneficiary use o
- Page 402 and 403: B.270335 400 of the care provided a
- Page 404 and 405: States Could Learn More From Improv
- Page 406 and 407: Targeted Analyses of Grievance Data
- Page 408 and 409: Observations Agency Comments and Ou
- Page 410 and 411: B-270335 408 Finally, the experts w
- Page 412 and 413: 410 Appendix I Scope and Methodolog
- Page 414 and 415: - I 412 App-edU I Sw Wd Methodology
- Page 416 and 417: 414 AppeAdt U Fedo.I aod Stt. Ove0s
- Page 418 and 419: 416 Appendix III Major Contributors
- Page 420 and 421: GAO July 1996 GAO/HEHS-96-120 418 U
- Page 422 and 423: B-26632 420 family home, rather tha
- Page 424 and 425: Background 1-206320 422 traditional
- Page 426 and 427: States Use Waivers to Expand and Ch
- Page 428 and 429: 84=20 426 Figure 1: Staftes Use of
- Page 430 and 431: B-266320 428 began the 1990s with s
- Page 432 and 433: B26320 430 variety of other service
- Page 434 and 435: Enrollment Caps and Management Prac
- Page 436 and 437: Change in Federal Rule Could Result
- Page 438 and 439: States Are Introducing Innovations
- Page 442 and 443: 440 We are sending copies of this r
- Page 444 and 445: C-m 442 Table 2: Changes in Number
- Page 446 and 447: 444 App-ar I So-p and Mraodsogo ent
- Page 448 and 449: 446 Appendix H Medicaid</st
- Page 450 and 451: 448 App-di. f M~I Wd., _. So 4 Of0
- Page 452 and 453: 450 App-.i. il _-.1 - Desd s UCFVA'
- Page 454 and 455: 452 Apeadls mn Stadad Seee - Defind
- Page 456 and 457: 454 Appedi. M St.d.ed Se&ee s Dneoe
- Page 458 and 459: Chore 456 Am..& IV LAO n.Gd .Mt. ,
- Page 460 and 461: Occupational Therapy and Assessment
- Page 462 and 463: Psychological Services Provider Typ
- Page 464 and 465: 462 AWppdi IV U-e, Cotfi-, E d Othe
- Page 466 and 467: Licensure/Registration Other Standa
- Page 468 and 469: 466 United States General Accountin
- Page 470 and 471: Results in Brief B-276078 468 care
- Page 472 and 473: B-270078 470 Medi-Cal was implement
- Page 474 and 475: _.27_7 Tab 1: Mad-C Eiglbli and Enr
- Page 476 and 477: ~~- - o~~BZ760?S 474 I J I the enro
- Page 478 and 479: B.276078 476 delaying the contracti
- Page 480 and 481: State's Education Process Has Not R
- Page 482 and 483: B.276078 480 and thereby supplement
- Page 484 and 485: Weaknesses in State Management of t
- Page 486 and 487: B-276078 484 standards can provide
- Page 488 and 489: Insufficient Communication and Invo
Agency Comments<br />
.2-sagas<br />
439<br />
Determining what recipients' choices are can be difficult for a number of<br />
reas<strong>on</strong>s. First many of these individuals have had little experience in<br />
making decisi<strong>on</strong>s and may also have difficulty in communicating. In<br />
additi<strong>on</strong>, some recipients have complained that they are not being<br />
provided the fange of choices to which they should have access and that<br />
quality m<strong>on</strong>itoring is too frequent or intrusive despite the changes states<br />
have introduced. However, c<strong>on</strong>cern has been expressed that quality<br />
assurance is not rigorous enough to reduce all health or safety risks and<br />
that the range of choices is too great for some individuals ' 3<br />
State officials and other experts we interviewed have emphasized the need<br />
for vigilance to protect recipients and ensure their rights. They have been<br />
especially c<strong>on</strong>cerned with assuring quality for recipients who are unable<br />
to communicate well and for those who do not have family members to<br />
assist them The states we visited are taking special precauti<strong>on</strong>s to try to<br />
assure quality in these cases-such as recruiting volunteers to assist and<br />
asking recipient groups to suggest how to assure quality for this vulnerable<br />
populati<strong>on</strong>. However, state officials and HCFA agree that more development<br />
of quality =asurance approaches is needed.<br />
Officials from the Office of L<strong>on</strong>g-Term <str<strong>on</strong>g>Care</str<strong>on</strong>g> Services in HCFA's <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g><br />
Bureau and from Florida, Michigan and Rhode Island reviewed a draft of<br />
this report They generally agreed with its c<strong>on</strong>tents and provided technical<br />
comments that we incorporated as appropriate.<br />
5ee Robrt G. Ebb ,- Whe-e, Oh WhF R C- S-,, He Coe. (0.1 Utrie Shoe D<strong>on</strong>t<br />
Ft Wh W- IretM-W 5Rterao AJe.l otPeby, d.d P -Vo 33 N. S<br />
(1995, pp. 1I7S3.<br />
P.Ae 21<br />
PgMEKS-W6t2o Wti P - f- D _ ,er .fy Diu d