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CMS Health Reform Updates and Trends in LTSS

CMS Health Reform Updates and Trends in LTSS. Michael Melendez, LMSW Associate Regional Administrator, Region II Division of Medicaid and Children’s Health Operations Centers for Medicare & Medicaid Services. November 21, 2013. CMS: Vision.

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CMS Health Reform Updates and Trends in LTSS

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  1. CMS Health Reform Updates and Trends in LTSS Michael Melendez, LMSW Associate Regional Administrator, Region II Division of Medicaid and Children’s Health Operations Centers for Medicare & Medicaid Services November 21, 2013

  2. CMS: Vision • Developing a sustainable health care system that supports independence, health and quality of life through effective, person-driven services and supports. • Continued LTSS System Transformation • Effective Integration of Services • Promotion of Strong Quality Principles

  3. Key HCBS Milestones

  4. Affordable Care Act – Tools for Rebalancing Systems • New opportunities created under the Affordable Care Act • Health Homes for Individuals with Chronic Conditions • Community First Choice State Plan Option • Balancing Incentive Program • Expansion and increased flexibility of current Medicaid programs • Money Follows the Person • 1915(i) State Plan Option Amendments

  5. Federal Olmstead Focus • Department of Justice enforcement efforts – 40 matters in 25 states in recent years • Settlement agreements • Litigation • Findings letters • HHS Office of Civil Rights • Complaints • Investigations • HHS-HUD-DOL-VA-DOJ Collaboration on policy and technical assistance

  6. HCBS Recent Proposed Rules • ANPRM (June 22, 2009) announcing the intention of CMS to publish proposed amendments to 1915(c) regulations including HCBS characteristics • Community First Choice NPRM – February 2011 • 1915(c) NPRM – April 2011 • Community First Choice Final Rule – May 2012 • 1915(i) NPRM – May 2012

  7. Housing • Housing Capacity Building Project • HHS/CMS collaboration/partnership with HUD to assist federal, state and local agencies and community partners to create effective/efficient coordination between housing and human service agencies. • Activities include training, regional meetings/training, intensive TA, etc. • Housing Informational Bulletin – June 2012 • http://content.govdelivery.com/attachments/USCMS/2012/06/18/file_attachments/135489/CIB-06-18-12.pdf

  8. Employment • September 16, 2011 Informational Bulletin – Updates to the 1915(c) Waiver Instructions and Technical Guide regarding employment and employment related services • Represents a two-year effort to provide clarification of existing CMS guidance on development and implementation of §1915 (c) Waivers regarding employment and employment related services.

  9. Workforce • CMS DSW Resource Center – • www.dswresourcecenter.org • PHI State Data Center on Direct Workforce • http://dswresourcecenter.org/tiki-index.php?page=datacenter • Technical Assistance

  10. Managed Care • Development of tutorial for States and CMS on managed long-term services and supports, and supports for community integration • MLTSS Online Resource - http://www.medicaid.gov/mltss/ • Developing guidance for States on MLTSS across authorities (including Duals Financial Alignment demonstrations) • Working closely with MMCO on financial alignment demonstrations

  11. Quality - MLTSS • Quality management systems should include standards and processes to ensure that: • Adequate safeguards are built into the design of the MLTSS to increase the probability of good outcomes. • Standard methods are used to define and measure the quality of services and outcomes. • Credible data and information are routinely collected and analyzed to assess program performance and identify opportunities for improvement. • Performance is improved based on the use of evidence-based practices.

  12. Quality Improvement • Revisions to 1915(c) quality improvement requirements • Promoting use of Adult and Children Core Quality Measures • LTSS measure development • CAHPS  Experience of Care tool

  13. Fully Integrated Duals Advantage (FIDA) • FIDA is a Demonstration Program • Testing innovative payment and service delivery models • Alleviate fragmentation and improve coordination for Medicare-Medicaid enrollees • NY FIDA Memorandum of Understanding • http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/NYMOU.pdf

  14. Federal Partnerships • Administration for Community Living • SAMHSA • Office of Civil Rights • Department Housing and Urban Development • Department of Labor • Department of Justice • Department of Veterans Affairs

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