5 Things an LTC Insider Is Seeing Now, for Agents

Many of your clients will eventually use the arrangements you have helped them make to pay for long-term care services.

Steve Shain may be helping the facilities or home care services those clients use get paid.

(Related: Scott Harrison Is Tired of Long-Term Care Policy Think Tanks)

Shain is chief operating officer if LTC Contracting, an arm of LTC Consulting Services of Lakewood, New Jersey.

Shain helps get nursing homes and other providers of long-term care services into the networks of managed care plans, including Medicare Advantage plan networks, commercial major medical networks, and managed Medicaid networks.

Other divisions of LTC Consulting Services help facilities get the payers to pay.

Here are some other things Shain talked about in a recent interview.

1. Payers

Shain’s clients do not get many patients who have private, stand-alone long-term care insurance.

When patients do arrive with private LTCI, the facilities usually ask the patients or their families to pay the facilities themselves, then seek reimbursement from the insurers, because determining what any given policy will cover can be tricky, Shain said.

Shain’s clients love seeing patients come in with Medicare skilled nursing facility benefits, and they are comfortable with taking Medicaid patients.

If Medicare would offer LTC benefits, “I think that is something they would be ecstatic about,” he said.

Helping patients qualify to get Medicaid nursing home benefits can take time, but, once people do start getting the benefits, Medicaid tends to be a steady payer, Shain said.

2. Patient-Driven Payment Model

In the acute care world, doctors often talk about “value-based plans,” or “patient-centered care.”

For Shain, the buzzword that matters is “Patient-Driven Payment Model,” or PDPM.

The Centers for Medicare and Medicaid Services wants to use the PDPM approach to hold own the cost of skilled nursing facility care for Medicare fee-for-service enrollees.

CMS hopes to use the PDPM to make payments to facilities based on each patient’s condition and care needs, rather than on the amount of care provided.