Ensuring Coordination of Services for Individuals with both Health and Long-Term Services and Supports Needs

Background

Many individuals with long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ( LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ) needs have chronic illnesses and other health conditions, such as heart disease, cancer, and multiple sclerosis. LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… and health care needs can impact each other. Lack of preventive and primary health services can lead to acute events and a worsening of functional limitations. Thus, it is essential to ensure that people with both health and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… needs receive all necessary care and that this care is coordinated whenever feasible.

Health-related and personal care service needs vary by condition and by the amount of assistance they receive from family and friends. Individuals may, for example, need nursing care but also assistance with the preparation of meals, paying bills, and transportation. This is especially true among people with chronic illnesses.

According to the Centers for Disease Control and Prevention data, chronic conditions include arthritis, hypertension, heart disease, diabetes, stroke, cancer, hepatitis, weak or failing kidneys, current asthma, and COPD. Chronic conditions can result in functional limitations, requiring some LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… . While medical insurance will cover services to address acute medical conditions, it does not typically cover personal care, adult day care, homemaker services These services include meal preparation, cleaning, laundry, shopping, and other household chores and may sometimes include informal monitoring of client status. , or transportation. Thus, many frail older adults lack the services and supports they need to function independently at home.

An increasing number of programs and plans are starting to recognize the benefit of offering a full range of medical and supportive services, as well as devising better ways to coordinate these services (see also Chapter 7, Health - Chronic Care Coordination, Medical Homes and Accountable Care Organizations for approaches to improving care for people with multiple chronic illnesses). With the consent of the person receiving services, efforts to incorporate family members and caregivers in the coordination and integration of service delivery can improve outcomes (see also Chapter 7, Health – Managed Care for Dually Eligible Medicaid Beneficiaries).

The Affordable Care Act created the Center for Medicare & Medicaid Innovation An office within the Centers for Medicare & Medicaid Services (CMS) that is charged with testing payment and service delivery models that reduce spending while enhancing the quality of care in Medicare and Medicaid. ( CMMI An office within the Centers for Medicare & Medicaid Services (CMS) that is charged with testing payment and service delivery models that reduce spending while enhancing the quality of care in Medicare and Medicaid. ) to support further efforts to integrate medical and supportive services. The center is testing new payment and service delivery models that have the dual goal of reducing Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid expenditures while preserving or enhancing quality of care. The center is also authorized to test new financing models that enhance care integration, particularly for individuals eligible for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid (dual-eligibles). These innovations may address some of the issues that confront people who receive services through both Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid and thus have to navigate two separate and complex delivery and financing systems.

Some service models integrate funding sources in an effort to provide a seamless service delivery so that individuals do not have to navigate separate systems to acquire and coordinate health and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… . Integrated financing options for people eligible for both Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid (known as dually eligible or duals) include the Program of All-Inclusive Care for the Elderly (PACE) and dual special-needs plans available through Medicare Advantage Medicare beneficiaries can get their Medicare benefits through Original Medicare or a Medicare Advantage Plan. If beneficiaries have Original Medicare, the government pays for Medicare benefits when they get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are… .

ENSURING COORDINATION OF SERVICES FOR INDIVIDUALS WITH BOTH HEALTH AND LONG-TERM SERVICES AND SUPPORTS NEEDS: Policy

Ensuring the coordination and integrated financing of health care and long-term services and supports

In this policy: FederalState

Federal and state governments should develop comprehensive, coordinated approaches to financing and delivering care to individuals whose needs are currently met through multiple service systems.

Policymakers should emphasize preventing disabilities and functional limitations among individuals with a chronic illness and minimizing disability or functional loss if one occurs.

Federal and state governments should proactively incorporate the needs of family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. in developing new financing and care delivery models that focus on coordination and quality improvement.

Good evaluations are needed to identify specific financing mechanisms and delivery systems to serve subgroups of chronically ill individuals who need both ongoing medical care and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ; for example, people with physical or mental disabilities, or both, and those eligible for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… or Medicaid (see also Chapter 7, Health – Health Care Coverage: Medicare).