SB12-127, Long-Term Care in Medicaid Care Coordination Programs

SB12-127

PARTICIPATION OF PROVIDERS OF LONG-TERM CARE IN MEDICAID CARE COORDINATION PROGRAMS

Sponsors:  Sen. Newell, Rep. Summers

Staff Name:  Lou Irwin

What the Bill Does:
This bill requires that the Department of Health Care Policy and Financing (DHCPF), if it establishes a program of health homes for patients with chronic conditions, to allow long-term care providers to participate. It also requires the DHCPF to permit long-term care providers to contract with regional care collaborative organizations (RCCOs), either as health homes or to provide primary, specialty, or long-term care support. 

Colorado Context:
The state demographer in the Department of Local Affairs estimates that between 2005 and 2015, the portion of Colorado’s population that is over sixty-five years of age will increase by more than twenty-three percent.  In 2009, Colorado had 19,867 beds in 210 nursing homes¹.  As Colorado’s population ages, it is expected to follow national trends in requiring more extended care, but in pursuing alternatives to traditional institutionalization for that care. The DHCPF is currently investigating the feasibility of implementing a health home program, including the involvement of RCCOs.

National Context:
Nationally, there are over 16,000 long-term care facilities, with 1.7 million beds ².  However, as the provisions of the Patient Protection and Affordable Care Act (ACA) ramp up, with particular emphasis on primary care and other care settings that provide cost-effective alternatives to hospitalization, more long-term care needs are expected to be filled by integrated health providers and organizations, and by home health care. This year will see an acceleration in the long-term trend away from hospital care ³. The ACA defines a health home as a model of integrated service delivery for persons with chronic conditions.  It authorizes states to implement a health home model, and provides an enhanced federal match of 90 % for certain costs, including comprehensive case management, care coordination, health promotion, comprehensive transitional care, patient and family support, referrals to community and social support services, and use of health information technology to link services.

Provisions of the bill: 

• Defines an “accountable care organization or collaborative” as  any model, scheme, or system adopted by the state that provides or pays for Medicaid benefits to beneficiaries through an integrated service delivery system
• Defines a “health home” as a designated provider, including a provider that operates in coordination with a team of health care professionals, or a health team selected by an eligible individual with chronic conditions, to provide health home services, as defined in the ACA.
• Requires the DHCPF to allow providers of long-term care services and supports to participate as health homes or as part of a health home that provides:
  • comprehensive care management;
  • care coordination and health promotion;
  • comprehensive transitional care;
  • patient and family support;
  • referral to community and social support services;
  • and the use of health information technology
• Allows the health home to consist of a multi-disciplinary team, including primary care management providers, behavioral health care providers, case managers, and providers of long-term care services and supports, including but not limited to nursing homes, alternative care facilities, day programs for the elderly, home care agencies, mental health centers, and community centered boards.
• Allows dually eligible persons (eligible for both Medicaid and Medicare) with chronic conditions, or persons needing long-term care,  to contract with accountable care collaborative organizations as a health home or to provide some or all of the services provided by the regional care collaborative organizations

Fiscal Impact:  Cannot be estimated at this time.  If the DHCPF decides to implement a health home program, this bill could increase state expenditures to include reimbursements to providers of long-term care services.  Potential savings could also be realized by transitioning to more efficient and effective home-based care. As the DHCPF has not yet decided whether to develop a home health program, and the mix of providers that would be included is not yet known, state expenditures and savings cannot yet be calculated.

¹ Centers for Disease Control and Prevention (http://www.cdc.gov/nchs/data/hus/hus10.pdf#117)

² Centers for Disease Control and Prevention (http://www.cdc.gov/nchs/fastats/nursingh.htm)

³ Rossheim, J: “2011 Health Care Trends: Home Health Care Hiring and More” (http://hiring.monster.com/ hr/hr-best-practices/recruiting-hiring-advice/strategic-workforce-planning/health-care-hiring.aspx)