State Dept of Health Moves to Implement MLTC Changes Enacted in 2018-19 NYS Budget
28 Aug, 2018
Though the NYS legislature and Governor Cuomo agreed on a State Budget on April 1, 2018, many of the changes in the Managed Long Term Care program are still in the planning stages for implementation. Here is the status of state budget provisions affecting Medicaid for seniors and people with disabilities, as of July 5, 2018. NEW: See Info on lawsuit filed challenging law regarding approval of advertising by Consumer Directed Personal Assistance organizations.
8/29/18 Update: Policy Guidance issued on limitation on number of licensed home care services agencies that an MLTC plan may contract with. See below.
WINS FOR CONSUMERS:
The Legislature Rejected Proposals to Cut "Spousal Protections" that would have impoverished married couples, denied critical medical and home care to sick spouses and children, and increased institutionalization. See NYLAG budget testimony
The Governor's proposal would have maintained Spousal Refusal only for members of Managed Long Term Care (MLTC) plans, denying this protection to those same married individuals when they initially apply for Medicaid in order to enroll in an MLTC plan. Also, many people who need home care are not allowed to enroll in MLTC plans at all -- those receiving Hospice Care, and those whose disabilities are less severe, who need only "housekeeping" services." And spousal refusal would have no longer been allowed for married individuals who do not need MLTC or other home care but still need Medicaid or the Medicare Savings Program for help with Medicare out-of-pocket costs,
The annual cap on Physical Therapy (PT) visits was increased from 20 to 40 visits per year.
Unfortunately, the budget leaves unchanged the cap on Speech and Occupational Therapy visits at 20 per year for each type of therapy. But the increase in PT visits to 40 visits per year will improve access for those in managed care plans as well as those using Medicaid fee for service.
Alarming Changes in the MLTC Program Enacted
The legislature rejected one of the Governor's proposals that would have excluded from MLTC plans those with an "Uniform Assessment System" score of 9 or lower. These individuals have been determined to need the least amount of personal care services. However, other changes were enacted that consumer advocates fear may be harmful to consumers. NYLAG was one of many organizations that submitted testimony opposing many of these changes. See NYLAG's 2018-19 Testimony posted here. Crain's New York Business quoted NYLAG's testimony stating that some of the changes in MLTC will “increase barriers to access” for those who need care. See "State looks to shrink financial burden for elder care" by Caroline Lewis, Feb. 21, 2018.
The State Dept. of Health sent a memorandum to MLTC plans describing many of the changes in April 2018, posted here. Please note that some of the implementation dates in that memorandum have been extended.
There is also a concern that it will be more difficult for an individual in a nursing home - now disenrolled from an MLTC plan -- to obtain home care services to return to the community. To address this, NYS DOH has said that a Conflict Free Eligibility assessment will not be required if the consumer seeks to re-enroll in an MLTC plan within 6 months of the disenrollment.
Status of Implementation: Though DOH expected that current MLTC members permanently placed in nursing homes would be disenrolled from MLTC plans on July 1 2018, this has been postponed while procedures are developed and CMS approval is obtained. There are reportedly about 18,000 MLTC members in nursing homes.
Many policies must be developed to implement this change. For example, when does the "clock" start ticking that counts down three months until the member is disenrolled? if the clock starts when the member is "permanently placed," what does that mean? Early indications are that the period in which Medicare is covering all or part of a rehab stay will not count toward the 3 months of permanent placement. For now, as of July 5, 2018, the existing policies and procedures remain in place.
Consumer advocates have urged that plans must give notice of a decision to consider them "permanently placed," which the consumer should have the right to appeal. These decisions must be made with involvement of the consumer, not unilaterally by a managed care plan or nursing home.
DOH has issued guidance to implement this legislative requirement to downsize the number of LHCSAs:
A related change is enactment of a two-year moratorium on the approval of applications seeking the licensure of Licensed Home Care Services Agencies (LHCSAs). This moratorium became effective on April 1, 2018 and will continue until March 31, 2020. Guidance on this moratorium and its exceptions, along with applicant information is at this link.
Backgrounder - NYS budget 2018-19 as proposed by Gov. Cuomo
Here is information about the originally proposed New York State budget for 2018-19. Click here to see the actual Health and Mental Hygiene (HMH) Bill and the Governor's Health and Mental Hygiene (HMH) Memorandum in Support.