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MLTC UPDATE 2017 - State Clarifies Guildnet Member Rights in Long Isl, Westchester, HomeFirst to leave Suffolk June 1st

23 May, 2017

This is a running news article with updates on Managed Long Term Care in NYS. 

 Please see archives for past articles:

KEY CONTACTS

  • State Dept. of Health Complaint Number for MLTC Problems - 1-866-712-7197  or
  • Request Conflict-Free MLTC Assessment - needed to enroll in an MLTC plan 
  • FIDA -  call NY MEDICAID CHOICE at 1-855-600-3432  (1-855-600-FIDA)  Fax   1-917-228-8601
  • For MLTC enrollment complaints - call NY Medicaid Choice -
    •  1-855-886-0570 (Advocates line)     1-888-401-6582 (Consumers line)  
    •   also e-mail mltctac@health.ny.gov
  • ICAN - OMBUDSPROGRAM FOR FIDA & MLTC    Phone:  844-614-8800    

May 2017 UPDATE

  • HomeFirst, an MLTC plan run by ElderPlan, announced it is also pulling out of Suffolk County. As reported in Crain's Health Pulse, this is  "... the latest example of an insurer narrowing its geographic coverage for chronically ill and disabled members, the health  plan confirmed on Friday. The decision 'was driven by the difficulties we encountered effectively staffing and serving the needs of members across such an expansive geographic area,' said a spokeswoman for the nonprofit MJHS, which runs Elderplan. The insurer will continue to cover members' services until they pick a new plan, she said.

    Crain's further reported, "The move follows the exit of another nonprofit managed long-term care plan, GuildNet, from Suffolk as well as Nassau and Westchester counties as of June 1. The two plans had covered 41% of the 5,735 managed long-term care enrollees in Suffolk County as of March. The state Department of Health is "closely tracking" the transition of members in Suffolk County following the exits of GuildNet and Elderplan, a spokeswoman told Crain's.  There are still 10 plans offering coverage in the county, including Fidelis Care and North Shore-LIJ Health Plan. Earlier this month in response to GuildNet's exit, the department had said there was "ample capacity and choice" in the managed long-term care program."

  • Guildnet Withdrawal from Nassau, Suffolk and Westchester - On May 13, 2017, NYS Dept. of Health sent over 4000 letters to members of Guildnet MLTC plan in 3 counties - Nassau, Suffolk and Westchester, clarifying information sent by Guildnet in April. (See April 2017 update below).  The State Health Dept. clarified that members are not required to find a new plan by June 1st, and may remain in Guildnet after that date, and that Guildnet is required to continue providing them with MLTC services.   The letter does confirm that this MLTC plan has requested to stop providing services in these 3 counties.   However, the letter states Guildnet must continue providing services "until a smooth transfer can be completed to your new plan."  Still not specified is what happens if the individual cannot find a plan willing to provide the same hours as Guildnet authorized.  Advocates maintain that members have the right to continue the same amount of services.   See letter posted here 

The letter gives contact information for  ICAN - OMBUDSPROGRAM FOR FIDA & MLTC    Phone:  844-614-8800    TTY Relay Service:  711   Website:   icannys.org      ican@cssny.org

April 2017 UPDATE

  • Guildnet notified members in Nassau, Suffolk and Westchester that its MLTC "...will no longer offer Managed Long Term Care (MLTC) services" in these counties "effective June 1, 2017.”  The notice sent in late March further states, β€œIt is important that you select a new MLTC plan before May 18, 2017 to assure a smooth transfer to your new plan."   Download a copy of the notice sent to Guildnet's over 4000 members in these 3 counties.  Here's more info about this change:
    • The letter further states, "You will continue to  receive services from GuildNet until your transfer to your new plan is complete." Advocates are informed that members WILL CONTINUE to receive Guildnet MLTC services even after June 1, 2017 if they do not select a new plan. 

    • Members will not be "auto-assigned" to a new MLTC plan if they do not enroll in one on their own. 

    • Despite the letter's wording, advocates are informed that if other MLTC plans do not authorize the same amount or type of services that the member now receives from Guildnet, they do not have to change plans.  Also, many MLTC plans are backed up and cannot schedule assessment visits until June or later.  Members may stay in Guildnet after June 1, 2017.  This is true regardless of what members may be told by staff of Guildnet, New York Medicaid Choice, or other organizations.

    • Also, some members have been notified that Guildnet will no longer contract with the home care agency that employs their home care worker.   Advocates were told by the State Dept. of Health that Guildnet must do "single case"  agreements with home care agencies.  This means Guildnet will still pay the home care agency to continue to provide services to individual members after June 1st,   even if that home care agency's contract with Guildnet ends on June 1st.   

    • The Guildnet Gold Plus FIDA Plan continues to be offered in Nassau County and Guildnet Medicaid Advantage Plus (MAP) Plans continue in Nassau and Suffolk Counties

    • Transition Policy Requested.  Advocates are asking the State to require the new plans (to which former Guildnet members are transferring) to continue the same services and same number of hours that Guildnet authorized.  So far, the State has not agreed to issue this "transition policy."  Transition policies require MLTC plans to continue the same services for 90 days that the consumer received before enrolling in MLTC, when the consumers are mandated to transition from fee-for-service personal care or CDPAP to MLTC.  See, e.g. MLTC Policy 13.13, MLTC Policy 13.01 (revised)(period was later extended from 60 to 90 days in MLTC Policy 13.10) (All MLTC policy directives available at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policies.htm).  The same protection should apply in this situation, where a plan is effectively closing down.  Advocates contend that the new plan should only be allowed to reduce services below the amount Guildnet had authorized if there is a change in the member's needs or circumstances, after giving proper advance notice of hearing rights. See MLTC Policy 16.06: Guidance on Notices Proposing to Reduce or Discontinue Personal Care Services or Consumer Directed Personal Assistance Services

    • The Guildnet letter does not give contact information for ICAN - the Independent Consumer Advocacy Network that contracts with the State Dept. of Health to provide information and advocacy for consumers about MLTC, FIDA, and  other managed care plans.  Members with questions or who have problems keeping the same hours, or facing disruptions in their care should call ICAN.   Phone:  844-614-8800  
      TTY Relay Service:  711   Website:   icannys.org    e-mail:  ican@cssny.org

    • Who IS AFFECTED – as of March 2017 - as shown in this chart comparing with Nov. 2016 enrollment, based on DOH enrollment data
      • 35% of all 5,735 MLTC members in SUFFOLK  (1,990 members)
      • 27% of  6,438 MLTC members in NASSAU (1,753 members) 
      • 10%  of 4,685 MLTC members in WESTCHESTER  (451 members)
    • Background - In November 2016, as reported in the NYLAG MLTC news update article, Guildnet notified the State Dept. of Health that it "will no longer enroll members in Nassau, Suffolk and Westchester counties, according to a letter its chief sent to the state Department of Health.  Alan Morse, CEO of GuildNet, told the Cuomo administration the 'calamitous state of reimbursement' made it no longer feasible to operate because the program was incurring 'substantial deficits.'"   See story reported in Politico dated Nov. 23, 2016.   On January 13, 2017, Crain's Health Pulse reported that Guildnet announced that it would hold off on giving the State the formal 90-day notice required before it exited from any counties.  Crain's quoted Alan Morse, the CEO of Guildnet, "We said we would hold off on giving them formal notice until we figured out how well they would address our needs and how we're going to make the program work," with Mr. Morse referencing MLTC reimbursement rates.

Please see archives for past articles:


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