Managed medicaid care our new paradigm handouts

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Managed medicaid care our new paradigm handouts

  1. 1. 4/23/2014 1 Managed Medicaid: Our New Paradigm Patsy Tschudy, RN, CCM, Directorof ManagedCare Cantex Continuing Care Network Paul Gerharter, RN, C, Director, Post-Acute Services Touchstone Communities … IndustryHistory • Medicare 1965 • Medicare HMO’s 1980s • Hospice 1982 • DRGs 1983 • TILEs 1989 • PPS 1998 • Harris County StarPlus Demonstration • Medicare PDP Programs – 2006 • Affordable Care Act - 2010 • Medicaid RUG transition - 2008-2010 IndustryHistory
  2. 2. 4/23/2014 2 • When??? – March2015 • Why??? – Increasing Lifespan – Increasing Beneficiaries – Workforce Decreasing ManagedMedicaid • Passed – 83rd Session • Medicaid HMO • Impacts 60K+ Facility Residents • 19 States Preceded Texas • HHSC – Standards & Regulations SenateBill -7 • Goal – Quality Improvement • ↑ Access • ↑ Outcomes • ↓ Cost • ↓ Readmissions • ↓ PreventableEvents SenateBill -7
  3. 3. 4/23/2014 3 • Eligibility – StateDetermines • 5 MCOs – Texas – UHC – Amerigroup – HealthSpring – Molina – Superior SenateBill -7 • MCOs - Distribute Enrollment Packets • Plans - Provide Care Coordinator • No Admission Pre-Certification • 100% Medicaid RUGs Reimbursement • Pay For Performance SenateBill -7 What Does This Mean To Referral Sources?? • Education: – Marketing – DischargePlanners – Physicians
  4. 4. 4/23/2014 4 What Does This Mean To Me? • Understanding – Change – AppropriatePlacement – Pre-CertificationRequirements • Prepare List – Facility Providers • Be Available - MCO Site Visits • Coordinate MCO Facility Orientation • Host Resident Council • Host Open House – Families • Review Admission Process • Review Documentation What Do I Need To Do Now? • Collaboration With Payors • Care Coordinator Involvement – CarePlanning & Family Meetings – DischargePlanning • HigherAcuity – Beds ToFill The Future?
  5. 5. 4/23/2014 5 • Current ClinicalSkills • Needed Resources – IVCertification – TPN – 24/7 RNs – Complex Wounds – Resp. Therapy – Pulmonary Unit - Vents The Future? Dual DemonstrationProject • Targets Traditional Medicare Beneficiaries and Medicaid Recipients • Effective 3-1-15 • Passive Enrollment to Medicare HMO over 6 Months • Goal: ↑ Care Coordination We Shall Overcome!!
  6. 6. 4/23/2014 6

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