On Thursday March 1 2018, ANCOR staff attended a session of the Medicaid and CHIP Payment and Access Commission (MACPAC) public meeting. During this session, MACPAC received an overview from its analysts of an upcoming draft June chapter on Managed Long-Term Supports and Services (MLTSS), titled “Tailoring MLTSS Programs for Individuals with Intellectual and Developmental Disabilities.” The chapter included themes identified through contract review and stakeholder interviews - including with ANCOR members. The themes were:
- Adding IDD supports to MLTSS in an incremental fashion;
- Engaging stakeholders; maintaining transparency;
- Ensuring timeliness requirements do not conflict with person-centered supports;
- The emergence of outcome-based payment arrangements; and
- Disruptions caused by MCO transitions.
In addition, the presentation highlighted reasons fewer states include individuals with IDD in MLTSS, including:
- Silos in administration of services for individuals with I/DD;
- Lack of data for capitation rate development;
- Difficulty in achieving cost savings;
- Resistance from the I/DD stakeholder community; and
- Underdeveloped relationships between managed care organizations and I/DD service providers.
In terms of next steps, it was recommended that these themes are incorporated into the June chapter and that MACPAC staff publish a supplemental issue brief on research results. In addition, it was recommended that MACPAC staff monitor state activity in light of expressed state interest in moving individuals with I/DD into MLTSS and to assess what if any changes are prompted by implementation challenges in some states.