Uncharted Waters: Managed Care and Long Term Care Provider Contracts

Abstract

This article presents an overview of the contracting issues critical to long term care providers and managed care organizations. It describes the special characteristics of managed care that affect long term care. The article then addresses the major areas of potential concern to long term care providers -- including risk, covered services, relationship of the parties, utilizaion review and fraud and abuse. Finally, the article concludes that, despite inevitable growing pains, long term care and managed care will necessarily become partners in this era of cost consciousness.

Keywords: managed care, long term care, reimbursement, regulation, negotiation, risk, covered services, utilization review, fraud, abuse

JEL Classification: H51, I11, I28, K12 ,K23, K20, K29, K32