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A Message From Our President

by Jun 16, 2017General

Pamela Zipperer-DavisMy name is Pamela Zipperer-Davis, and I am the President of CareStar, Inc., a case management organization with four offices throughout the State of Ohio, serving Ohio Medicaid Waiver beneficiaries in 88 Ohio counties. CareStar has been in business since 1988 and has a 95.4% patient satisfaction rating.

In addition to serving individuals in the Ohio Home Care Program, we serve thousands of other individuals that have chronic and complex health conditions and disabilities. These individuals can have commercial insurance, Medicare or Medicaid. In addition, CareStar Information Systems, Inc., has developed and provided, since 2005, the software to the Ohio Department of Medicaid for case management in the Home Care Program.

CareStar has a passionate interest in seeing the waiver programs grow throughout the State of Ohio with decreased costs, improved consumer satisfaction and improved outcomes. We can collectively achieve this with other agencies, the AAAs, the Ohio Department of Medicaid, advocacy groups and providers.

We are opposed to the current proposal by the Ohio State Legislators to move long-term supports services (LTSS) to managed long-term support services (MTLSS).

1. We do not think the State of Ohio will save dollars by moving LTSS to MLTSS. The track record of other states (e.g. Iowa, Texas, Minnesota, New York and Massachusetts, to name a few) that have taken this path is proof of this assertion. Given all the requests for additional dollars for very worthy causes throughout the state, why are we rushing the implementation of MLTSS? Please note the links below that address many of the issues from the transition in other states.

http://www.thegazette.com/subject/news/health/survey-iowa-medicaid-providers-not-getting-paid-on-time-running-into-billing-issues-20160725

https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/CareCoordinationIssueBrief508032017.pdf

2. The implementation plan released by the State is inadequate, even for an implementation plan that is written at a summary level.

3. The movement of LTSS into managed care creates a conflict of interest for managed care plans. Managed care plans make profits by decreasing medical costs, which can result in denied services and claims.

· Preauthorization issues have slowed care to individuals. Preauthorizations should not be allowed, since there is an assessment and independent entity review already in place.
· On Monday, June 12, 2017, a suit was filed in the State of Iowa because plans were cutting benefits to Medicaid Waiver beneficiaries.

  * Please note the links below.

https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/Transitioning-LTSS.pdf

https://aspe.hhs.gov/basic-report/how-have-long-term-services-and-supports-providers-fared-transition-medicaid-managed-care-study-three-states

http://www.modernhealthcare.com/article/20170615/NEWS/170619935?utm_source=modernhealthcare&utm_medium=email&utm_content=20170615-NEWS-170619935&utm_campaign=am

4. The transition of MyCare to managed care in the State of Ohio has not gone well. The MyCare transition is 2½ years into a 5-year measurement period and issues are pervasive. While some want us to believe the transition has gone smoothly, radio ads run throughout the State asking those with problems to call their Ombudsman. The 1915i/SRS Program (Behaviorial Health Program for those with persistent mental illness) transition to managed care has also not gone smoothly. Since July 1, 2016, when 1915i (SRS) moved to managed care, CareStar has only been paid on 20% of claims to the plans.

5. Managed care is complicated, and it will be tough to navigate for individuals with complex health conditions and permanent disabilities. The State needs to do this well, and not rush the transition.

· MCPs have had difficulty finding, retaining and training appropriate staff. You will note this in some of the literature in the links above.
· House Bill 49 does not require the utilization of private case management agencies.

We thank all for taking the time to read our position that moving LTSS to MLTSS is a big mistake for all Ohioans, and we will regret it. We need to learn from the 23 states that have gone before us, none of which have moved the volume of programs Ohio is planning to move. Please write your senators and representatives, with a cc to Senator Dave Burke, to let them know that you do not support LTSS moving to MLTSS July 1, 2018.