CMS APPROVES OHIO MEDICAID PLAN TO ENHANCE CARE AND PREVENT COMPLICATIONS FOR THOSE WITH CHRONIC ILLNESSES
CMS Administrator Mark B. McClellan, M.D., today approved a plan by Ohio to improve the quality of care delivered to Medicaid enrollees with chronic and sometimes life-threatening illnesses. The new State Plan service is aimed at keeping those with chronic illnesses healthy and avoiding the need for expensive treatments and hospitalizations.
Ohio will institute a new system of care for the chronically ill that will assign case managers to nearly 25,000 Medicaid enrollees by the end of next year.
“The case managers in this promising new program will work closely with the health professionals treating each beneficiary,” said Dr. McClellan. “That means there will be better coordination of the activities of the entire treatment team – physicians, mental health providers and social service agencies to prevent overlaps or gaps in the care plan – and better education of patients and their families about how they can get the most out of all of these services.”
Case managers will also work closely with clients to urge compliance with medical regimens and to educate the person about their disease. There will be no copayments associated with this new service because it is expected to lead to both overall cost savings and better outcomes.
Called “Enhanced Care Management, (ECM)” the program will be targeted at aged, blind or disabled consumers with specified conditions such as diabetes, congestive heart failure, coronary artery disease, asthma, chronic obstructive pulmonary disease and non-mild hypertension. Children under age 21 who have asthma will also be covered under the new, voluntary program.
In addition to direct assistance with the management of their specific health care needs, participants in the program will also receive:
- access to a 24-hour nurse helpline,
- an enhanced care monthly Medicaid card that allows them to obtain their medical services.
- access to all of the medically necessary services that are covered by the Medicaid benefit package,
- the right to cancel membership in the ECM program at any time, and
- no co-pays.
The program will have an emphasis on the role of the physicians as well as the involvement of other local providers and agencies currently serving the target population. Supplemental payments will be made to primary care providers of ECM consumers. Qualified ECM plans will be required to work closely with local medical, mental health and social services organizations. The project is expected to improve the health and quality of life for the ECM consumers and reduce the cost of care for Ohio’s Medicaid population.
“As a physician, I know how the importance of a focused case management program designed to help patients with complex diseases and their health care providers follow an effective plan of care,” said Dr. McClellan. “The use of case managers for patients with potentially costly diseases can greatly enhance understanding and compliance, and that means fewer complications and better quality of life for people with these diseases.”
The program will be phased-in to seven urban and eight rural counties: Cuyahoga, Franklin, Hamilton, Lucas, Montgomery, Start, Summit, Coshocton, Guernsey, Morgan, Muskingum, Noble and Perry. The State hopes to begin enrolling beneficiaries in the new program September 1st .
“Encouraging collaborative relationships between patients, their health care providers and social service agencies is critical to the provision of high quality health care services,” said Dr. McClellan. “I hope everyone who is eligible signs up for this great new service.”
Medicaid is a state/federal partnership program created in 1965 to provide health care services to certain low-income persons such as children, pregnant women, aged, blind and disabled Americans. Medicaid currently serves over 41 million people. Together, states and the federal government spent $276 billion on the Medicaid program in fiscal 2003.