Calling the report that will be coming out of the meetings of the Managed Long-Term Services and Supports (MLTSS) Study Committee a "resource document" for the next General Assembly and governor, co-chair Rep. Mark Romanchuk (R-Mansfield) told Hannah News it will help decide how the state should proceed on the question of moving long-term services into the managed care system.

Romanchuk, who had been among those in the House lobbying for a more in-depth look at the administration's proposal when it surfaced in the last biennial budget process (see The Hannah Report, 2/8/17), said these hearings had helped him understand what all is entailed in the recommendation -- echoing the comments of his co-chair Sen. David Burke (R-Marysville). Burke told the group Thursday that, while he does not envision the report's making any recommendations or including a "call to action," it has been a valuable step in moving forward. He said they will look for areas of agreement among the group's participants and assured those at the meeting that its does not end with this meeting and eventual report.

Romanchuk, too, commented that the budget process is just a "too compressed" time for such in-depth study, adding that it is better to have the conversation now. He did wonder just how soon a new governor, faced with "thousands" of decisions, will get to this matter. "It's not easy; it's not black and white."

Burke went on to say that a process such as this study committee helps legislators get "up to speed" on hard-to-understand issues, commenting that after a decade in the General Assembly, he feels as though he "is probably just now getting my GED in these matters."

Referencing his remaining 26 months in the Legislature, Burke said he is interested in leaving a legacy for those who follow so they will not "have to start all over."

Sen. Bob Hackett (R-London), the only other legislator in attendance at the group's last meeting, echoed his colleagues' sentiments, saying in his experience constituents care about "health and money." Arguing concerns from a variety of perspectives around the question of controlling health care costs and specifically mentioning both nursing homes and hospitals, he cautioned against the managed care plans going the way of pharmacy benefits managers (PBMs). He said PBMs initially provided a "great service," "but they screwed up." He urged the managed care plans "not to work the system against us [the state]."

Thursday's meeting of the study committee heard the state departments along with stakeholder groups provide their perspectives on cross collaboration and the policies, procedures and infrastructure that would need to be in place for the "efficient implementation and administration of a managed long-term services and supports environment."

Patrick Stephan, the Ohio Department of Medicaid's (ODM) head of managed care, led off the comments, speaking also for the departments of aging and health and the Office of Health Transformation. He said the four critical areas they have identified for nurturing cross collaboration include the following:

- Care management/care coordination is the foundation for cross collaboration.

- Transitioning individuals to the community requires every partner working on their behalf.

- The social determinants of health must be assessed and addressed.

- Value-based reimbursement promotes improved health outcomes.

Acting State Long-Term Care Ombudsman Erin Pettegrew said that, based on her office's experience with MyCare Ohio, the following are their recommendations:

- Create an advisory committee.

- Require the managed care plans to directly provide outreach to agencies such as nursing homes.

- Involve stakeholders in the design of the policies and procedures, with Pettegrew mentioning some specifics such as timely access to information and being able to back-date enrollment.

- Support a "robust" consumer support system.

- Require the managed care plans to consider the recommendations of their advisory committees.

- Require strong contract management.

- Assure consumers receive the right care at the right time.

LeadingAge Ohio CEO Kathryn Brod offered the following:

- Revise the current system for measuring quality of care because it is done in "siloes." "Aligning these entities [for example, nursing facilities, hospices, and health plans] according to shared measures, and by extension, shared goals, will foster collaboration and partnership within the care system and lead to more person-centered results."

- Reduce the burdens on providers.

- House care coordination with the entity closest to the individual. Consider subcontracting care coordination.

- Pay claims and settle disputes in a timely manner.

- Create a central billing portal and refine the definition of a "clean claim." Implement incentives and/or penalties to incentivize plans to adhere to these payment parameters and timelines.

Jane Taylor, speaking on behalf of the Ohio Aging Advocacy Coalition, recommended the following:

- Don't forget about the unpaid caregivers.

- Don't forget about other sources of support such as local levies in providing services to seniors.

- Strengthen the oversight of the plans and the Medicare Advantage Plans.

- Integrate the area agencies on aging into future plans.

Jean Thompson, representing the Ohio Assisted Living Association, stressed the need for reviewing the reimbursement of providers. She also suggested the following:

- Better utilize assisted living providers in the future plans.

- Implement an alert in the payment system when a patient's liability changes. "CRIS-E had such an alert."

Miranda Motter of the Ohio Association of Health Plans suggested the following:

- Identify where the gaps are in the current system by mapping out care coordination.

- Identify and align quality measures.

- Build a model that encourages choice and quality and outcome-based purchasing.

- Streamline administrative processes.

Ohio Association of Area Agencies on Aging CEO Larke Recchie made the case for the work area agencies on aging (AAAs) have done for over 30 years in managing "the intersection between aging consumers and LTSS providers in Ohio's Medicaid program," noting they have saved the state "billions" in that time. She encouraged building on that success by doing the following:

- Align revenue and payments by implementing a value-based purchasing strategy.

- Understand that "duals" are more likely to require intense services -- particularly those in rural areas that do not participate in MyCare.

- " … create new models of collaboration at transition points, manage chronic conditions well, and prevent inpatient and nursing facility admissions."

- Avoid the mistakes of MyCare by assessing the readiness of providers to implement the changes.

Deb Studer of the Council for Home Care and Hospice seconded the idea of an advisory committee, suggesting including those on this study committee, but adding that it be housed in the Legislature to assure it will continue to meet. She also suggested the following:

- Standardize processes among managed care plans.

- Simplify administrative burdens, mentioning the idea of paring the managed care plans to three.

Peter Van Runkle, executive director of the Ohio Health Care Association, commented that what struck him with today's conversation is that "long term services and supports have existed long before managed plans came into the picture." He delineated where that occurs -- i.e. in the nursing homes and by the AAAs -- adding that MyCare "might be effective for those unconnected persons" but long-term supports are already in place for many. He said the managed care plans only duplicate what is already being done, "adding additional cost."

He also noted that nursing facilities already do a multitude of assessments of patients -- which should be built on, not duplicated. He noted the transition period from hospital to skilled facility to home is difficult to negotiate.

Van Runkle, also, made the case for timely payment.

The Ohio Olmstead Task Force representative Renee Wood stressed the need to have consumers at the table, noting that they have different needs and abilities. She, too, supported an advisory committee and asked that whether to move forward be based on the cost benefits.

The AARP Ohio representative suggested "robust state oversight" of the plans, that the services be person- and family-centered and that family caregivers be involved.

Loren Anthes of the Center for Community Solutions was the last to offer comments. He suggested the following:

- Eliminate regulatory capture by providers. "In order to ensure that alignment take place between the various settings and services associated with this benefit, finances need to support value, evidence and patient preference. For these reasons, leveraging law to protect the interests of any single provider type maintains regulatory capture by the industry in ways that do not benefit the patient or the long-term financial health of the state."

- Develop a long-term care workforce strategy.

- Identify who already performs case management and "ensure the case management is taking place in settings that are most effective and place those entities at increasing levels of financial risk for failure."

- Reduce the provider burden.

- Address social determinants.

Written testimony from the Thursday meeting of the study committee can be found on the Hannah News homepage at www.hannah.com >Important Documents and Notices>Library.