Federal and State Initiatives to Integrate Acute and Long-term Care: Issues and Profiles

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Nova Publishers, 2001 - Political Science - 86 pages
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In exploring integration of acute and long-tern care, this book begins by characterising the dually eligible population, and describing problems associated with meeting their health and social service needs in an uncoordinated system. It continues by analysing the advantages of using capitation and care management as a vehicle for integrating those services, and by discussing concerns about care integration strategies. It concludes by profiling nine federal and state programs that to varying degrees, integrate the acute and long-term care services that people who are dually eligible for Medicare-Medicaid, often require. They are: Federal initiatives such as the Program for All-inclusive Care of the Elderly (PACE), which capitates both Medicare and Medicaid acute and long-term care services for those who are dually eligible, and the Social/Health Maintenance Organization (S/HMO) and EverCare demonstrations, which capitate Medicare benefits only; Comprehensive state demonstrations such as Minnesota Senior Health Options, the Wisconsin Partnership Program, and the Continuing Care Network Demonstration of Monroe County, New York, which, like PACE, capitates both Medicare and Medicaid benefits; and Capitated state Medicaid demonstrations such as the Arizona Long-Term Care System, Oregon Health Plan, and Florida's Community-Based Diversion Pilot Project, which capitate Medicaid only, but actively pursue various Medicare co-ordination strategies. Proposals that explore using care management techniques to integrate Medicare and Medicaid services delivery, without capitation, are also discussed briefly. The book concludes with the observation that although federal and state initiatives to integrate acute and long-term care for those who are dually eligible, only serve a relatively small percentage of this population, they provide a set of options which Congress may want to examine when formulating long-term care policy in the future.
 

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Contents

DUAL ELIGIBLES DEFINED
3
SEPARATE SYSTEMS
8
IMPLICATIONS
10
MEDICAREMEDICAID SYSTEM REFORM GOALS
12
FEDERAL AND STATE INITIATIVES SERVING MEDICAREMEDICAID DUEL ELIGIBLES
19
CONCERNS ABOUT INTEGRATING ACUTE AND LONGTERM CARE
31
Evidence of Risk Selection and Concerns about Inadequate Risk Adjustment
36
AN ALTERNATIVE TO CAPITATION
41
POLICY IMPLICATIONS
45
SUMMARY OF FEDERAL AND STATE INITIATIVES FOR INTEGRATING ACUTE AND LONGTERM CARE FOR MEDICAID DUAL ELIGIB...
49
DETAILED PROGRAM PROFILES
55
WAIVER AUTHORITIES
79
INDEX
83
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