Managed Care and Integrated Services

Part of LeadingAge's 2020 Policy Priorities

LeadingAge Advocacy Goals

  • Pursue new payment model demonstration(s) that give post-acute and long-term service and support providers the opportunity to lead by accepting both the financial risk and rewards of the model.
  • Identify and advocate for the inclusion of basic rights or protections for providers in managed care programs that ensure beneficiary access to services and provider viability.
  • Support and advocate for policy initiatives and models that take a more holistic and integrated approach to address the needs of older adults and align incentives for all participating providers.

The Issue

Aging services providers in many parts of the country have reached a tipping point where managed care – Medicare Advantage, Medicaid managed care, and CMMI payment reform initiatives -- is the dominant payer. Under these programs, providers face inadequate payments on top of increased expectations and administrative burden of these contracts (often presented as a take it or leave it), all of which in turn is threatening their viability and beneficiary access.

Source: “34th SNF Cost Comparison and Industry Trends Report,” CliftonLarsonAllen, accessed at: https://www.claconnect.com/resources/white-papers/2019/-/media/files/white-papers/2019-snf-cost-comparison-and-industry-trends-report-cla.pdf

Advocacy Action 2020

116th Congress

  • Community-based ISNPs: We support the Community Based Independence for Seniors Act of 2019 (HR 3461) to establish a community-based ISNP demonstration program.
  • Medicare for All Proposals: There are several Medicare for All proposals; LeadingAge is neutral on these efforts to promote full insurance coverage and delivery reforms under the rubric of Medicare.

Executive Branch

  • Working with Managed Care: Identify and pursue new language to be included in the Medicare and Medicaid managed care regulations, including the Medicare Managed Care Manual, that clarifies certain rights of providers, obligations of plans in their interactions with providers, and seeks to streamline and/or standardize required elements of participation in these programs to reduce administrative burden.
  • MA Call Letter: Monitor Medicare Advantage Call Letter and annual regulatory changes.
  • Medicaid Managed Care and LTSS: Monitor Medicaid managed care regulations relating to LTSS.
  • New Models of Integrated Care: Engage Center for Medicare and Medicaid Innovation in further development of a new demonstration or model(s) that would allow post-acute providers and/or LTSS providers to be accountable and financially at-risk for the care of a population or an episode of care.
  • IMPACT: Monitor and contribute to MedPAC discussions on the development of the unified prospective payment system for post-acute care.

Actions You Can Take Now

  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how managed and integrated care policies impact providers and older adults’ access to needed services.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support approaches to health coverage and managed care that enable aging services providers to play a central role.

Additional Resources