Proposal Presented for the Master Plan for Aging (#14)
Disclaimer
Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.
Summary
Introduce a care mandate that incorporates mental, behavioral and physical health for managed care plans. The proposal includes a plan to work with CMS for the needed program changes.
Justification
Mental, behavioral, and physical health need to be better incorporated into managed care plans via a care mandate to ensure members are monitored for social isolation, cognitive impairment, and other conditions that are a threat to their health. Social workers play a crucial role in enhancing health systems, particularly in Medicaid Managed long-term Care, by promoting population health and reducing health inequities, especially for individuals experiencing loneliness, substance abuse, and dementia.
Full Proposal
Introduce a care mandate that incorporates mental, behavioral and physical health for managed care plans. Have social workers monitoring plan members for social isolation, substance abuse, and dementia, so that treatment for those conditions can be incorporated into care plans. Work with CMS to assess adjustment to rates.
- DOH to coordinate with CMS and Managed Care Plans to evaluate necessary changes to Managed Long-Term Care (MLTC) plans for improved screening and staffing needs for case management.
- DOH to draft a mandate and determine funding allocation in coordination with CMS.
- DOH to introduce a care mandate based on conversation with CMS and Managed Care Plans.
- DOH to coordinate with CMS and Managed Care Plans for plan to address the care mandate.
This proposal is focused on primary and secondary prevention.
MPA Council Commentary
This proposal is categorized as long-term. While Managed Care Plans are mandated to provide person-centered care planning including connection to necessary treatment, a comprehensive evaluation of the MLTC program may be necessary before the introduction of a care mandate. Following an analysis of the MLTC program, DOH may provide any necessary guidance for modifications to program-mandated person-centered care planning. Medicaid reimbursement methodologies and funding allocations would be subject to the annual budget process and the availability of resources.