Consumer Advocates Call for Further Protections in Medicaid Managed Long Term Care

Consumer advocates have submitted several comments to the New York State Department of Health and the Centers for Medicare and Medicaid Services (CMS) that would protect the rights consumers as Managed Long Term Care is implemented.  

April 30, 2013 - Consumer Advocates Meet with State Medicaid Director Jason Helgerson

As reported in the New York Times on May 1, 2013 --  

Advocates Say Managed-Care Plans Shun the Most Disabled Medicaid Users

At a meeting with the advocates for disabled people, New York State’s Medicaid director vowed to hold plans accountable when it came to enrolling the most seriously impaired seniors, participants said....  click to read full article ...  Mr. Helgerson agreed to address the serious concerns raised by advocates for seniors and people with disabilities -- from delays in enrollment due to technical computer coding problems to denials of service to high-need individuals.  

April 5, 2013 - New York’s 2012 Managed Long Term Care Report: An Incomplete Picture

The Coalition to Protect the Rights of New York’s Dually Eligible issued this "Incomplete Picture" Report as a critique of the NYS Dept. of Health's 2012 Managed Long Term Care Report, issued in December 2012.  The  State's Report does not provide the full spectrum of information that beneficiaries need to make informed health care choices -- For exampe, The 2012 Report presents the most favorable findings of consumer surveys, but fails to mention less positive but important findings from IPRO’s report, including the fact that higher need respondents in poorer health were significantly more likely to raise concerns about services than those in good health.  The Report fails to include any meaningful utilization data, showing the amount of and type of services provided by MLTC plans or the medical-loss ratios of the various plans.  The Report fails to comply with the Public Health Law that requires the report to  present information  in a way that allows beneficiaries to make meaningful comparison between plans.  Inadequate quality data is reported as well.  

February 27, 2013 - Due Process Protections Ensured in Assembly bill  A. 4996

Empire Justice Center calls for due process protections in Managed Long Term Care, supporting Assembly Bill A.4996.  See EMPIRE JUSTICE MEMO OF SUPPORT: ENSURE DUE PROCESS FOR CONSUMERS IN MEDICAID MANAGED LONG TERM CARE PROGRAM

December 7, 2012 -- New York State Assembly Hearing on managed long term care transitions.  

On December 7, 2012 both the Assembly committees on health and oversight, analysis and investigation held a hearing on the transition from fee-for-service long term care to insurance-based managed long term care.

Beneficiary advocates expressed concerns about the transition of this very vulnerable population into private managed long term care plans. Concerns included inappropriate reductions or interruptions of care, inadequate information for beneficiaries, and insurer capacity to take on the large number new beneficiaries. 

Beneficiaries being enrolled into managed long term care plans now will be enrolled into fully integrated dual advantage plans (FIDA) plans in 2014, if New York’s demonstration proposal is approved by the federal government. FIDA plans would cover a beneficiary’s managed long term care services, and provide Medicare, Medicaid, and drug coverage.

Many of the same concerns that apply to managed long term care implementation will apply to FIDA implementation.

During the hearing, advocates, legal service providers, health care providers, insurance plans, and state officials testified about managed long term care and FIDA plans, outlining how beneficiaries were affected, and how the state legislature can help improve the implementation process.

There was a consensus amongst many of the groups that the implementation roll out was occurring too quickly. The groups also noted that additional resources were needed to ensure adequate monitoring of health plans as managed long term care enrollment grows and FIDA plans are developed.

The Coalition to Protect the Rights of New York’s Dually Eligible presented testimony in three parts.

• To read Part I of the Coalition’s testimony, click here --  re problems with managed long term care and the need for immediate legislative action 
• Part II, click here -- re applying lessons from managed long term care implementation  to FIDA plans.
• Part III, click here -   the need for robust beneficiary assistance and Ombudsprograms to help New Yorkers navigate these programmatic shifts.

The Empire Justice Center submitted this testimony calling for consumer protections. 

October 2012 - Letter from CIDNY Describing Inadequacy of ADA Appendices of MLTC Plan Contracts with NYS DOH. 

Analysis completed by the Center for Independence of the Disabled NY (CIDNY) found MLTC Plans woefully out of compliance with the aforementioned ADA requirements.  Letter to Mark Kissinger, Dep. Commissioner NYS DOH, dated  Oct. 5, 2012, from Susan Dooha, Exec. Director, CIDNY, posted at  http://tinyurl.com/CIDNY-MLTC-ADA, referencing Chart Comparing MLTC ADA Plan Compliance, posted at http://tinyurl.com/CIDNY-MLTC-ADA-chart-xls.  

August 29, 2012 - Consumer Letter to CMS Calling for Protections in MLTC

A letter was sent on August 29, 2012 from The Legal Aid Society, Empire Justice Center, NYLAG, CIDNY, and other consumer, disability rights and community-based organizations asking for further protections in rolling out MLTC.   Consumers ask that MLTC be rolled out more gradually, so that it starts with new applicants seeking home care only, rather the tens of thousands of people already receiving personal care/home attendant services.   Consumers also express concerns about appeal rights being limited if and when MLTC plans reduce services compared to what the individual previously received from the Medicaid program.  See the letter for other issues. 

March 2012 -- Proposed Incentives for  Plans to Provide Community Based Services

 Incentives for Community-Based Services and Supports in Medicaid Managed Long TermCare: Consumer Advocate Recommendations for New York State.    It is posted at http://wnylc.com/health/download/304/.  

In his written State of the State address, Governor Cuomo explicitly acknowledged the civil right of people with disabilities to live in the most integrated setting as affirmed in the Supreme Court’s Olmstead decision and set forth a proactive agenda for supporting people with disabilities in the community: community-based services, housing, and jobs. In response to this directive, consumer advocates recently released a proposal to incentivize community-based services and supports in New York’s Medicaid managed long term care system.

“As we move thousands of New Yorkers with disabilities and seniors into mandatory managed long term care, it is imperative that the state builds in the right incentives to support people with the most significant disabilities at home,” stated Susan Dooha, Executive Director for the Center for Independence of the Disabled, New York. “It is not only fiscally responsible, it is the law.”

Most states are recognizing the importance of incentivizing community-based services and the health plans are supporting this direction. The State already submitted its application for the 1115 waiver for managed long term care, but many decisions for implementation, structure, and contract requirements are still on the table.  These requirements will pave the way for the larger waiver the State is planning that will incorporate ALL Medicare and Medicaid services for dual eligibles.   The State's basic proposal on that waiver is posted online, with comments due on April 20th.  

“The time is now,” stated Trilby de Jung, Health Law Attorney at the Empire Justice Center. “If we are not proactive in the process, we will be forced to go back and fix our errors; at the detriment to seniors and people with disabilities who will find themselves in unwanted nursing facility placements.”

“Our proposals will strengthen the managed care plans' capability of serving people in their homes and communities, ensuring that the redesign of systems of providing long-term care services incorporate vital resources and consumer protections,” said Valerie Bogart, Director of the Evelyn Frank Legal Resources Program at Selfhelp Community Services, Inc.

The proposal was written by staff from Selfhelp Community Services, Inc., Empire Justice Center, Center for Disability Rights, and the Center for Independence of the Disabled -New York, and was signed on by numerous other consumer-advocacy organizations. 

December 2011 - Consumers Express Concerns to CMS

On December 27, 2011, Legal Aid Society, New York Lawyers for the Public Interest, and many other organizations expressed concerns to CMS in this letter.   These concerns include violations of due process in fair hearing appeals.

May 2011 - Letter to State Department of Health with Proposals for Implementation of MLTC

On May 2, 2011, Selfhelp Community Services led numerous organizations in submitting these comments, explaining numerous concerns about the expansion of MLTC