VHCA Submits Comments on DMAS LTC Blueprint

As shared with the membership last week, on Tuesday, November 28th, the Virginia Department of Medical Assistance Services (DMAS) announced that it is moving forward with the development of a blueprint for the integration of acute and long term care by issuing a draft of a recently completed report – Blueprint for Integration of Acute and Long-Term Care. The report includes a number of specific plans for transitioning away from the traditional model of funding long term care services in the Commonwealth.  In the 2006 General Assembly Session, Governor Kaine and the General Assembly directed DMAS “to develop a plan which will serve as the blueprint for moving toward an integrated, acute and long term care delivery system for elderly and disabled Medicaid recipients.”  Following this mandate, DMAS researched and held public meetings to discuss how the Virginia Medicaid program can best accomplish this goal.

Based upon our review of the draft coupled with input provided by a number of VHCA members, we submitted our comments to the Department on Monday, December 4th.  As outlined in last week’s eMemo, the draft DMAS report outlines the Kaine administration's plan to aggressively pursue changes to the current state-funded (Medicaid) long term care delivery system within the Commonwealth.  An initial step in this plan includes the development of seven new sites operating as Programs of All Inclusive Care for the Elderly (PACE).  Within the next several years, Virginia plans to add additional PACE sites as well as develop regional managed care models that will include both elderly and disabled Medicaid beneficiaries (including dual eligibles) who are receiving all forms of Medicaid services – including long term care services provided in both nursing facilities and in home and community-based settings. 

The full text of VHCA’s comments on the Blueprint report are available on the VHCA website. Key observations made in our comments include:

• We support the development of additional PACE sites as outline in the Blueprint report as one component of a strategy to provide comprehensive long term care services to Medicaid beneficiaries.
• Given the characteristics that define Virginia’s current Medicaid program for nursing facility care – low cost and low reimbursement, relatively low utilization coupled with high acuity resulting from our stringent admission criteria and generally high facility occupancy – it appears that many of the objectives that Medicaid managed care programs are created to achieve have already been met.
• Supporting claims that meaningful alternatives to nursing facility placement are available, through the aggressive expansion of home and community based waiver programs, the Commonwealth has experienced significant growth over the last five years in Medicaid expenditures for long term care services provided outside of facility settings .
• A recent study indicates that a very small percentage of existing Medicaid residents in Virginia nursing facilities could be cared for in a home or community based setting.  Less than two percent of existing residents have the necessary family and informal caregiver support structures to insure that they could receive reliable, high quality health care services.
• The Blueprint report fails to address a wide array of operational and financial considerations that must be fully evaluated prior to any meaningful announcement for a new approach to Medicaid funded long term care in the Commonwealth.

We concluded our comments with the observation that as baby boomers age, all levels of long term care will be necessary to keep up with the demand for services.  Innovative policies will be needed to care for the frail and elderly in the most efficient and cost-effective setting.  We repeated our pledge that the VHCA stands committed to work with other providers of long term care services and with DMAS to provide the most appropriate care for Virginia’s frail elderly and disabled citizens.  We wish to thank our members who reviewed the DMAS draft Blueprint report and provided their comments and concerns.