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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
[...]Published Date: April 15, 2019 -
Billing for Services: Key Considerations for Providers
Your organization may be required to change billing practices upon contracting, or entering into an agreement, with a health plan. Submitting a formal medical billing claim form may be a new experience for your organization. Your organization may be used
[...]Published Date: April 15, 2019 -
Identifying Community-Based Resources: Key Considerations for Health Plans
Community-based resources may address the needs of members dually eligible for Medicare and Medicaid that are sometimes not met through formal relationships with providers. This is particularly relevant for health plans deploying navigation, care coordination, and peer support programs in-house.
[...]Published Date: April 15, 2019 -
Training and Credentialing: Resources for Health Plans
As states expand managed long-term services and supports (LTSS) for their Medicaid enrollees, your health plan may need to engage or contract with a variety of LTSS providers, including existing licensed home and community-based service providers and direct service workers
[...]Published Date: April 15, 2019 -
Oversight of Durable Medical Services: Key Considerations for Health Plans
Health plans increasingly will be required to manage, monitor, and oversee a broader range of services as more states contract for managed long-term services and supports (LTSS). Oversight includes preventing fraud and abuse, which requires ensuring that the services billed
[...]Published Date: April 15, 2019 -
Monitoring the Delivery of Personal Care Services: Key Considerations for Health Plans
Health plans increasingly will be required to provide oversight for a broader range of services as more states contract for managed long-term services and supports. These services may include personal care services delivered by direct service workers (DSWs). Monitoring the
[...]Published Date: April 15, 2019 -
Oversight of Transportation Services: Key Considerations for Health Plans
Health plans increasingly will be required to oversee non-emergency transportation services as more states contract for managed long-term services and supports (LTSS). Oversight often refers to preventing fraud and abuse, which requires ensuring that the services being billed are actually
[...]Published Date: April 15, 2019 -
Contracting with Behavioral Health DSWs: Key Considerations for Health Plans
Behavioral health long-term services and supports (LTSS), such as health navigation, peer support, and developmental therapy, assist members in maintaining independence by coordinating resources and care, serving as mentors and personal models of recovery, and integrating appropriate developmental supports. As
[...]Published Date: April 15, 2019 -
Assessing the Capacity of HCBS Providers: Key Considerations for Health Plans
Home and community-based services (HCBS) encompass a broad range of services and supports designed to help older adults and people with disabilities live in their homes and communities rather than in institutional settings. If your health plan operates in states
[...]Published Date: April 15, 2019 -
Identifying & Engaging Behavioral Health-Focused LTSS Providers: Considerations for Health Plans
As your health plan becomes engaged with persons eligible for both Medicare and Medicaid – particularly those with behavioral health needs, developmental disabilities, or substance abuse challenges – you may find it necessary to provide behavioral health long-term services and
[...]Published Date: April 15, 2019