New CoLTS Program has been implemented

CoLTS, the new managed long-term services program that will serve an estimated 38,000 Medicaid recipients in New Mexico, has been fully implemented.

Known as Coordination of Long-Term Services or CoLTS, the program is a joint initiative of the New Mexico Aging and Long-Term Services Department and the New Mexico Human Services Department.

“CoLTS is designed to address the fragmented mix of institutional, state plan, and home- and community-based services,” said Human Services Department Secretary Pamela Hyde. “It also will improve the limited coordination and integration that currently exists across long-term services programs in Medicaid.”

CoLTS has several goals, including:

• Offer seamless access to a choice of culturally responsive, appropriate, and quality long-term services;

• Provide a system of services that minimizes stays in institutional settings, such as a nursing home, by increasing access to less restrictive home- and community-based services;

• Promote improved health status and quality of life and reduced dependency on institutional care;

• Use best practices from other states seeking to improve coordination and reduce fragmentation.

The Aging and Long-Term Services Department (ALTSD) will manage the program. “CoLTS will cover primary, acute, and long-term services in one coordinated and integrated program that will incorporate Medicare and Medicaid services and funding in an approach that will be seamless to the recipient,” said ALTSD Secretary Cindy Padilla. “This new approach will continue to provide necessary services to New Mexicans in a more efficient and effective manner.” 

Enrollees will consist of several groups of people:

• Those currently enrolled in New Mexico’s CoLTS C waiver program (formerly knows as the Disabled and Elderly (D&E) waiver program);

• Adults receiving personal care services from the Medicaid Personal Care Option (PCO) program;

• Residents of nursing facilities;

• Individuals who are fully eligible for both Medicare and Medicaid, but who have not yet accessed the system of long-term services in the state; and

• Certain qualified individuals with brain injuries.

The cornerstone of CoLTS is coordination of care and services. Care coordination that encourages maximum involvement of the consumer/participant in the service planning process will result in more services being available in home- and community-based settings, and decreased dependency on institutional levels of care.

Two managed-care organizations—AMERIGROUP and Evercare—have been selected as the contractors to implement this program. Both companies are national corporations with experience managing long-term care services in several states. Both were selected after a review of responses to a Call for Proposals, and both have been active participants in the planning process to develop the program.

AMERIGROUP’s mission is to improve healthcare access and quality for low-income Americans by developing innovative managed health services for the public sector, including a focus on long-term care populations. They serve more than 1.2 million people in the District of Columbia, Florida, Georgia, Maryland, New Jersey, New York, Ohio, Tennessee, Texas, and Virginia.

Evercare coordinates health care and well-being services for people who have long-term or advanced illnesses, are elderly, or have disabilities. Started in 1987, Evercare today serves more than 120,000 people nationwide through a variety of Medicaid, Medicare, and private-pay health plans, programs and services in the home, the community, and skilled nursing facilities.

Stakeholder involvement has been critically important in developing the concepts of CoLTS. Advocates, providers, Native Americans, other government partners, and consultants have helped design the program. These participants have provided valuable input regarding enrollment, transitions, communication, quality, outreach, provider relations, and many other issues.

Waiver applications for CoLTS were submitted in early July 2007, and the Centers for Medicare and Medicaid (CMS) is currently reviewing our proposals. An interagency implementation team has been formed to assure that once CMS approves the waivers, the state will be ready to implement the program.

The development of CoLTS has been, and continues to be, a collaborative effort among ALTSD, HSD/MAD, and valuable stakeholders. With this ongoing cooperation and participation, New Mexico intends to continue to rebalance its Medicaid long-term supports and services system from heavy reliance on nursing facility services to extended use of home- and community-based services.

CoLTS will improve and expand coordination of acute-care and community-based services and supports, and will establish a consumer/participant-focused continuum of services across each enrollee’s lifespan. The over-arching goal is to improve the health status and quality of life for all consumers/participants.