On August 31, 2012, the Center for Medicare and Medicaid Services (CMS) agreed to amend both of its managed care demonstrations to include long-term services and supports (LTSS) on a mandatory basis. As part of the approval, CMS amended the Special Terms and Conditions (STC) that govern New York’s operation of the demonstrations. The STC are significant both because they will govern New York’s amended demonstration, and also because the provisions of the STC give an indication as to how CMS may handle other states’ proposals to move LTSS into a managed care structure. Read More (PDF).
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Unfinished Business: Designing Appeals Procedures in the Dual-Eligible Demonstrations helps stakeholders focus their advocacy about appeals on areas where a consumer voice can have the most potential to affect programs, by highlighting the many areas where appeal rights and procedures have not yet been fully developed. – December 2014
What’s In A Notice? How Notices Of Action Protect Consumers In Medicaid Managed Long-Term Services and Supports provides advocates with the specific information that must be included in each notice of action to meet due process requirements, and outlines how continuation of services and aid-paid-pending plays out in the managed LTSS context. – November 2014
Conflict Free Case Management: Themes in States Implementing New Systems provides background on conflict-free case management and reviews existing regulations and guidance. – October 2014
Action Steps for Consumers and Advocates Regarding the New Home Care Rule: How to Prevent Service Cuts and Protect Consumer-Directed Programs provides steps that consumers and advocates should take in their states to ensure proper implementation of new federal rule. – September 2014
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