The State Dept. of Health has moved ahead to implement the changes enacted in the State Budget in late March 2011.  The changes are generally described in this article .   Here is information on the status of implementation of some of the changes -- some of which require a "waiver" from the federal Medicaid agency, CMS, and/or require the State to amend its State Medicaid plan, which also requires CMS approval.  

1.   Expansion of Mandatory Medicaid Managed Care 

The State submitted a request to amend the 1115 waiver to CMS on April13, 2011.  The State's letter to CMS, description of the changes, and Timeline for proposed implementation are all posted at http://www.health.ny.gov/health_care/managed_care/appextension/ -- all under the first heading labeled Amendment to Implement Medicaid Redesign Team Changes to the 1115 Waivers.  

This initial expansion would not require Medicare beneficiaries to enroll in a Medicaid Managed Care plan.  The initial expansion would mandate these populations and services .. for later groups, see the entire Phase-In Schedule  proposed by DOH.  Note that all of this is subject to CMS approval, which is pending.  

• 7/1/11 - Recipient Restriction Program individuals enrolled

• 8/1/11 - Personal Care services will no longer be "carved out" from the Medicaid managed care benefit package.   Those individuals who otherwise are mandated to enroll in a Medicaid managed care plan and who now receive Personal Care (home attendant in NYC) approved by their local Dept. of Social Services (CASA) would now have these services authorized by their managed care plan.  SEE MORE INFORMATION IN THIS NEWS ITEM posted July 29, 2011

  • DOH issued  this "GIS" Directive June  7, 2011 --  11LTC008 - Personal Care Services Changes for Non-Dual Eligible Persons Participating in Mainstream Managed Care Programs(PDF, 20KB, 2pg.)

  • Note that  those receiving consumer directed personal assistance program (CDPAP)  willNOT be required to enroll in a Medicaid managed care program in August 2011.  They will be required to enroll in July 2012.

  • About 5800 Medicaid recipients statewide (we heard about 4200 of these live in NYC) who now receive personal care services will be affected by this and will be required to enroll in a Medicaid Managed Care plan.  

  • SEE MORE INFORMATION IN THIS NEWS ITEM posted July 29, 2011. 

• 10/1/11 and later -- see Phase-In Schedule  

• For information on how Medicaid Managed Care has worked prior to these changes, see this article.  

Consumer Comments on the Managed Care Expansion

• The Legal Aid Society submitted these comments, joined by other organizations.  They are posted on the DOH website.

2.     Requirement that Most Medicaid Home Care Recipients and Applicants Enroll in a Medicaid Managed Long Term Care Plan 

The state budget will  mandate, subject to CMS approval,  that all personal care, long-term home health agency (CHHA) recipients and applicants, and other home care recipients to be designated by DOH, enroll in a Managed Long Term Care Plan.

DOH requested CMS approval for this change in the same April 13, 2011 1115 waiver request with which it requested expansion of Medicaid managed care, described above.    See ttp://www.health.ny.gov/health_care/managed_care/appextension/ -- all under the first heading labeled Amendment to Implement Medicaid Redesign Team Changes to the 1115 Waivers.  The details on the Managed Long Term Care expansion request begin at Page 3 of the Summary of MRT changes.   

Consumer Comments on the Managed Long Term Care Expansion

• Selfhelp Community Services submitted these comments, signed by numerous other organizations, which are posted on the DOH website.  

3.     Reduction in "Housekeeping" Personal Care from 12 to 8 hours/week maximum

GIS 11- LTC- 007 - New State Law Requiring Automatic Change To No More than 8 Hours Per Week of Nutritional and Environmental Support Functions (Level I) For Personal Care and CDPAP Consumers Who Are Authorized to Receive Only Nutritional and Environmental Support Functions 

• State form Notice of Intent to Reduce Houseeeping Services (attachment to GIS)
• State form Notice of Intent to Reduce CDPAP Housekeeping Services (Attachment to GIS)

4.     Medical Equipment and Supplies

State DOH has already revised its instructions to providers  to include these changes in equipment and supplies.

• Prescription footwear and inserts are only allowed for part of a lower limb orthotic appliance as part of a diabetic treatment plan
  • Pricing Methodology Change for Orthopedic Footwear - May 10, 2011 (28KB)
  • Prescription Footwear Benefit Update - April 5, 2011 

• Compression stockings only for pregnancy or treatment of venous stasis ulcers.   See Stockings Benefit Update

• Enteral Nutritional Formula Benefit Update - April 18, 2011 (PDF 20KB)  - imited to cover nasogastric jejunostomy, or gastrostomy tube feeding; nutritional or dietary supplements are not covered.  

The above updates are posted at http://www.emedny.org/providermanuals/DME/communications.html.  

Also see this  Procedure Codes  Manual for DURABLE MEDICAL EQUIPMENT, ORTHOTICS, PROSTHETICS, AND
SUPPLIES, updated in May 2011.  

5.    Other "Medicaid Redesign Team" activities 

See other documents posted on the status of changes proposed by the DOH Medicaid Redesign Team and its current activities, public meeting schedule, etc.   See http://www.health.state.ny.us/health_care/medicaid/redesign/.    Among recent postings is MRT Proposals Project Management Plan  

This news item posted by Selfhelp Community Services, Inc.