Contracting with Providers: Key Considerations for Health Plans

As more states expand managed long-term services and supports (LTSS) options, there will be new opportunities to integrate acute and long-term care. This will require plans, which may already have considerable experience contracting with acute care providers, to negotiate agreements with LTSS providers. LTSS providers include nursing facilities, personal care agencies, and other home and community-based service (HCBS) providers, as well as paid caregivers under participant-directed service options, that is, when members are allowed to hire, train, and manage their own direct service workers. These providers may have limited experience contracting with health plans.

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