Issues HCBS Providers may Negotiate with Health Plans: Key Considerations for Providers

As more states shift to managed long-term services and supports (LTSS) for their Medicaid programs, your organization may need to contract with health plans. Health plans may be accustomed to contracting for institutional-based acute care services but may not have as much experience with the LTSS that you deliver, often in the community. This brief outlines key issues that may be addressed and negotiated in the contract the health plan offers you. Although the state may specify many of these issues in its contract with the health plan, there still may be flexibility around how the health plan actually implements them.

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