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July 1, 2021, brought with it a tsunami of new challenges in Medicaid with the rollout of the five Standard Plans (aka Prepaid Health Plans) in Managed Care. Providers had to get busy contracting, learning about new authorizations, case management rules and billing and payment systems under these new entities.
Tailored Plans Slated to Start December 2022- 6 NEW Managed Care Entities (that’s a total of 11 plans in addition to NCTracks)
Despite continuing challenges with the Standard Plans, Medicaid is planning to roll out the Tailored Plans- SIX NEW entities- with a Go Live date of December 1, 2022. These new entities are partnerships between the current LME/MCOs and some of the Standard Plan PHPs designed to manage both the physical and behavioral health needs of residents.
Which residents will become members of the Tailored Plans? To put it simply, if your resident is Medicaid only, meaning not receiving both Medicaid and Medicare benefits, they will be in either a Standard Plan or a Tailored Plan by December 2022. There are a couple of exceptions including those dual eligible on the innovations waiver or TBI waiver.
Medicaid Rates
If you have not been checking the PCS rate schedule daily, you may have missed one of the 9 rate changes that has occurred since March 2020. The current rate, for June 2022, is $23.84 or $5.96 per 15- minute unit. As of this writing, June 27, 2022, we know what the rate will be through mid- July 2022 but not for how long that rate will be in place.
There are a few factors that may impact this rate moving forward. The most important of these factors, is whether Medicaid is granted flexibility or additional funding in the State’s Budget. Another factor is the potential for an extension of the Public Health Emergency, which may provide funding to help keep the current rate in place. A third factor is whether the extension of HCBS money through the American Rescue Plan Act, now extended to 2025, will allow more flexibility for rates.
Regardless of how this sausage gets made, many providers are seeking advice on how to set wages and budget without confidence in the stability of the future rate? That’s the right question to ask. The answer may be to avoid committing to increasing the wage base while the uncertainty lasts, and instead make one-time bonus or special payments to pass along what you can to workers. Although we all believe in committed wage increases is necessary for the future.
Stay tuned for upcoming webinars hosted by NCALA featuring SembraCare and LTSS Consulting to discuss these very hot topics.
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