Descember 23, 2005

Medicaid Reform Commission Releases Recommendations Report

The Medicaid Reform Commission met this week to finalize its report to the Missouri General Assembly. The commission spent two days reviewing a draft report developed by the commission’s chair, Sen. Charlie Shields, R-St. Joseph. He developed the report based on previous committee discussions. The revised report will be circulated for member endorsement during the coming week and submitted to legislative leaders by the end of the year.

The 70-page report includes numerous recommendations organized into 10 categories. Among the recommendations are the following proposals.

• rename the MC+ Medicaid managed care program as “coordinated care” and expand it to include children and adults in the St. Joseph and Springfield areas and counties contiguous to the current MC+ regions, particularly those surrounding the St. Louis and Kansas City regions
  
• create two pilot projects that would allow elderly and disabled recipients the option of enrolling in a managed or coordinated care model. One model would involve a private risk-based delivery system. The other would feature an administrative services organization model in which the management firm would have performance standards but not retain financial risk.
  
• establish incentives to emphasize enrollees’ personal responsibility for maintaining health by using risk appraisals and other tools to educate recipients about healthy practices
  
• promote management of chronic disease, including coverage of tobacco cessation programs
  
• create a tiered system of copayments to promote patient compliance and empowerment
  
• allow the benefit package to vary based on an enrollee’s category of eligibility and health needs
  
• establish a pilot project to assess a “pay for performance” program for Medicaid providers
  
• promote, and eventually require, the use of electronic medical records and electronic prescribing systems
  
• provide incentives to promote the use of telemonitoring technology and other telemedicine technologies
  
• improve provider reimbursements
  
• provide a primary care case manager for all Medicaid recipients
  
• improve transparency of data on health care cost and quality, with the goal of “creating structures to guide participants to be better consumers of health care”
  
• explore options for emergency department physicians to direct patients with nonemergency conditions to alternative care settings as appropriate
  
• promote or offer patient consultation telephone hot lines staffed by nurses
  
• use tax credits or other incentives to promote purchasing private long-term insurance coverage
  
• establish a single point of entry for assessing a patient and assigning him or her to the appropriate level of care
  
• base Medicaid nursing home payments on patient acuity
  
• promote improved access to care through tax credits for the purchase of insurance or purchasing pools
  
• provide technical assistance in supporting grants to create or expand federally qualified health centers
  allow small businesses and uninsured employees to purchase coverage through the Missouri Consolidated Health Care Plan, which covers state employees
  
• require the Missouri Consolidated Health Care Plan to offer coverage to its enrollees through a health savings account arrangement

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