The PACE and ALTCS programs primarily target those at risk of institutionalization who meet the State's criteria for nursing facility level of care, i.
Similar to PACE, ALTCS places contractors at risk for all LTC services.
The ALTCS capitation payment is an example of a single rate derived from a blend of several components: institutional costs, HCBS costs, the mix of HCBS and institutional costs, and other costs (acute care, behavioral health care, case management, administration, and profit).
Utilization data examined for Arizona beneficiaries are encounter data submitted by the LTC program contractors, FFS claims paid by ALTCS, and Medicare data from HCFA's national claims history data base.
Assessment data for ALTCS beneficiaries are from a computerized system maintained by the State.
This resulted in a total of 4,915 ALTCS beneficiaries and 3,019 New Mexico beneficiaries.
Initial results from the HCFA-funded evaluation of ALTCS have shown that the program has been successful in providing HCB services as a cost-effective alternative to nursing home care (McCall, Crane, Bauer, et al.
A key feature of the ALTCS program, for the purpose of this study, is that both nursing home care and HCB care are covered services, thus enabling us to assess the factors that are associated with the transition between care settings.
Of the 5,789 noninstitutionalized elderly and physically disabled (EPD) clients who had a long-term care placement in the ALTCS program during a three-year period-January 1989 through December 1991-about half (n = 2,866) were initially placed in a nursing home and the other half (n = 2,923) in HCB care.
The study described here compares the acute care service utilization experience of elderly and physically disabled ALTCS beneficiaries with that of elderly and physically disabled beneficiaries in a Medicaid FFS program.
The ALTCS program capitation payment does not cover Medicare payments for Medicare-covered services used by beneficiaries who are dually eligible for Medicare and ALTCS, although it does include Medicare deductible and copayment amounts.
In the sample that Bauer (1996) used to analyze the ALTCS
program, the average number of ADL dependencies was three.