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

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beneficiaries on July 1, 1997. This expansion will result in the management of
behavioral health services by additional fully capitated health plans.
Regardless of the contractual arrangements developed by capitated health plans and
behavioral health care organizations, Oregon anticipates that existing community
mental health networks will continue to provide a significant portion of those
services to <strong>Medicaid</strong> beneficiaries. Prior to the 25% demonstration, traditional
providers expressed apprehension that assumption of behavioral health service
management by capitated health plans would seriously erode their client base. That
fear, however, has diminished, and the community programs appear more willing
to participate in both formal contracts and informal partnerships with fully capitated
plans in the future.
Long Term <strong>Care</strong> Providers
Finally, managed care plans will need to develop relationships with a range of long
term care providers. The type of arrangement will depend upon the scope of
capitation. If long term care services are not part of the scope of services, referral
and coordination will be needed with the long term care systems and providers of
residential, home, and community based services. If the scope of service and
capitation payment includes long term care, plans will need to contract with these
providers.
Developing a network of community-based long term care providers may be
difficult for plans. While plans have experience contracting with home health
agencies, other agencies may be able to provide personal care and homemaker
services more cost effectively. Home delivered meals, transportation, companion
services, chore service and respite care can all be delivered by multiple community
organizations.
The multitude of individual agencies that exists may discourage plans from
contracting with these agencies. Plans can frequently sign one contract with one
organization with multiple providers to obtain physician and other medical
services. There is no identical provider consolidation in the community based long
term care system. However, more loosely organized home care networks typically
managed by local area agencies in aging (AAAs) and counties do exist in the current
long term care system. These local, independent agencies are responsible for
contracting, monitoring and quality assurance activities. However, contracting with
these individual agencies could be time consuming and difficult for plans since
standards for these agencies differ from those of health care providers. Many
community agencies are not required to meet licensing standards common to health
providers. States might be able to help address this issue by creating contract
specifications that allow plans to contract with agencies that meet state requirements
for participation in the state's home and community based services program.
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