MANAGED CARE EFFECT Sample Clauses

MANAGED CARE EFFECT. The blended nature of the NFLOC rate cell encourages MCOPs to manage the mix of the population towards lower cost settings. This is the basis for efficiencies in LTSS programs. This transition between settings (e.g. nursing facility to HCBS waiver services) is gradual in nature and is not an immediate transition. Most often, individuals that are in a nursing facility for a long period of time have lost their community supports and it becomes difficult to change the setting away from a nursing facility. Therefore, MCOPs will need to seek individuals that are newer to LTSS benefits and avoid or delay nursing facility placement. Because of this, we assumed gradual increases in HCBS percentages and decreases in nursing facility percentages. Our assumption for CY 2018 is that the number of individuals in a nursing facility will be reduced by 1% in favor of HCBS for the year. This assumes MCOPs will achieve a shift of 1% on the entire year’s NF enrollment, or a gradual uniform shift ending at a 2% rebalancing factor by the end of CY 2018.
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MANAGED CARE EFFECT. The blended nature of the NFLOC rate cell encourages MCOPs to manage the mix of the population towards lower cost settings. This is the basis for efficiencies in LTSS programs. This transition between settings (e.g. nursing facility to HCBS waiver services) is gradual in nature and is not an immediate transition. Most often, individuals that are in a nursing facility for a long period of time have lost their community supports and it becomes difficult to change the setting away from a nursing facility. Therefore, MCOPs will need to seek individuals that are newer to LTSS benefits and avoid or delay nursing facility placement. Because of this, we assumed gradual increases in HCBS percentages and decreases in nursing facility percentages. Our assumption for CY 2017 is that the average mix between HCBS and nursing facility will shift by 1% in favor of HCBS for the year. We believe this assumption is reasonable, appropriate, and attainable, as the MCOPs reported on a composite basis for the Opt-Out population in the June ▇▇▇▇ ▇▇▇ cost reports a 2% rebalancing shift from January 2016 through June 2016.
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