NYLAG has been publishing a running news article with updates about the roll-out of Managed Long Term care. The most current news is posted here http://www.wnylc.com/health/news/41/. - includes updates since Jan. 1, 2014.
Earlier postings from 2013 are in this article
More information about Managed Long Term Care is posted here
On Nov. 13, 2013, NYC HRA issued a revised FAQ that clarifies procedures for MLTC plans to enroll members who have a spend-down. Plans often improperly deny enrollment because the consumer has a spend-down. Instead, they are supposed to fax HRA a "conversion package" to activate Medicaid when the consumer has a spend-down. Other counties should have similar procedures. A full article on this Medicaid eligibility "coding" problems will be posted on this site soon. Download Conversion cover sheet here.
CMS approved mandatory enrollment in MLTC plans to begin in Orange and Rockland counties. The "front door" to apply to the local Medicaid program is closed as of Sept. 23, 2013 for personal care, Consumer-Directed Personal Assistance Program and adult day health care services. Individuals already receiving any of those services in these counties, as well as those receiving private duty nursing services, are beginning to receive the so-called "announcement" letter from the State Dept. of Health that explains the changes, but does NOT require the individual to join a plan. See also Spanish version -- Aviso importante de Medicaid
About 30 days after receiving that letter, the individual will then receive a letter from NY Medicaid Choice --Form Letter to Personal Care/Home Attendant recipients -- the enrollment broker under contract with the State Dept. of Health, requiring them to join an MLTC plan (or PACE or Medicaid Advantage Plus) within 60 days, or they will be randomly assigned to a plan. The letter will include a Guide to MLTC, along with lists of plans by geographic area, which can be downloaded from NY Medicaid Choice website. See http://nymedicaidchoice.com/program-materials.
On Sept. 24, 2013, New York State announced that "spousal impoverishment protections" are available to married participants in all Managed Long Term Care (MLTC) plans, including PACE and Medicaid Advantage Plus plans. See NYS DOH GIS 13 MA/018 Spousal Impoverishment and Transfer of Assets Rules for Certain Individuals Enrolled in Managed Long Term Care. These protections have long been a hallmark benefit to married spouses participating in the Lombardi or Long-Term Home Health Care Program (LTHHCP). The Lombardi program is gradually being phased out. Current Lombardi program participants in the mandatory MLTC counties are being required to enroll in an MLTC plan if they are dual eligibles. Many married Lombardi participants in the mandatory counties faced tremendous financial hardship if the spousal impoverishment protections did not continue once they transitioned to MLTC. Read more about it here
Statewide chart showing plans in each county with current enrollment (updated for July 2013). Last page shows month to month growth in enrollment. Enrollment statistics are updated monthly by NYS DOH here -- Monthly Medicaid Managed Care Enrollment Report
On August 12, 2013 State DOH directed MLTC plans to begin disenrolling people who need only "Housekeeping" services, also known as Level I Personal Care services, as described in 18 NYCRR 505.14(a). Though as Medicaid personal care recipients they were originally required to enroll in MLTC plans, DOH has now decided they do not meet the criteria for MLTC and should remain in the fee-for-service Housekeeping service administered by HRA and other local DSS programs. New people needing these services may resume applying at their local CASA/DSS. As a result of budget cuts in 2011, these services are now limited to 8 hours per week. MLTC plans may of course continue to provide housekeeping services to people who also need "Level II" personal care - that is, assistance with activities of daily living suchas grooming, bathing, mobility, transfer, dressing, etc. The same personal care aides assist with all of these activities.
In July 2013, there are now 23 partial-capitation MLTC plans in NYC alone, plus 10 Medicaid Advantage Plus plans and 2 PACE plans. Many upstate counties that previously had NO MLTC,PACE, Or MAP Plan now have one. All counties next slated for mandatory enrollment later in 2013 have at least 2 plans.. (Rockland, Orange were supposed to begin mandatory enrollment in June 2013 but it has been delayed, and Albany, Erie, Onondaga and Monroe are slated for later in 2013). Total of 104,872 people in MLTC plans as of July 2013, of which 95,643 are in NYC.
This chart shows the July 2013 enrollment figures by county and by plan for all three types of plans. At page 4 of the document is a chart showing enrollment in NYC. At page 5 of the same document is a chart showing monthly total enrollment comparing upstate, NYC and statewide for MLTC and PACE plans. The monthly enrollment data is compiled from DOH stats posted at http://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/.
NYC MLTC-MAP-PACE Plan List by Company - NYC July 2013.pdf --showing which different MLTC/MAP/PACE plans are offered by the company as of July 2013 - New York City only
MLTC members no longer have to disenroll from MLTC plan when they need to enroll in hospice care. MLTC should "wrap around" and supplement the hospice care, which is provided separately by a hospice. BUT - anyone receiving hospice services is still excluded from first enrolling in an MLTC plan. If they are already in MLTC, they don't have to disenroll from the MLTC plan in order to get hospice care.
NEW MLTC PLANS -- New York Times -- State Rewards Home Care Firms Once Rebuked (Nina Bernstein, June 24, 2013) - investigating award of MLTC contracts to two companies that sponsor Certified Home Health Agencies that have a history of Medicaid fraud.
Since April 2013, the State. Dept. of Health has issued several policy bulletins that clamp down on who is eligible for MLTC.
First, in April and May, the State said that people who need only Social Adult Day Care (SADC) and not any home care or other long-term care services are not eligible for MLTC. SEe MLTC Policy 13.11: Social Day Care Services Q&A (PDF 119KB) Letter from State Medicaid Director Helgerson to MLTC Plans on SADC. This was in reaction to the influx of people into MLTC recruited by the pop-up SADC centers.
Next, earlier in June, the State said that people who need only "Housekeeping" -- formally known as Personal Care Level I services (18 NYCRR 505.14(a)), are not eligible for MLTC and must be disenrolled by the plans. When given alone, Level I services are limited to 8 hours/week. The State's instructions to plans were given in a series of 3 directives, all posted on MRT 90: Mandatory Enrollment Managed Long Term Care
NYLAG'S Evelyn Frank Legal Resources Program sent an e-mail to State DOH on June 25th alerting them to serious problems with mass disenrollment of people who allegedly need only Housekeeping. The State apparently expected the plans to refer these individuals back to their local DSS/CASA office which was to reinstate the Housekeeping services that were previously cut off when the individual was required to enroll in an MLTC plan. But -- there are no clear established procedures to make this transition happen, and it was very likely to disrupt these important services. Moreover, the State said the members could not appeal the plans' decision that the member was not eligible for MLTC because she solely needs Housekeeping ad not other MLTC services. A complete copy of NYLAG's e-mail to the State is copied below.
As a result of NYLAG's advocacy, the State agreed to suspend these disenrollments for at least a month while procedures are developed. An e-blast was was sent by State DOH to all MLTC plans today, June 26, 2013, postponing these policies for one month or until a date to be announced, and requiring plans to halt any disenrollments already initiated. Here is the language of the State's e-blast sent June 26th:
The purpose of this email is to advise MLTC plans that the Department of Health, in order to assure coordination of activities with local social services districts related to refining the definition of community based long term care services to exclude individuals requiring discrete Level I housekeeping services, has delayed the implementation of MLTC Policy 13.15: Refining The Definition of CBLTC Services for one month. MLTC plans who have initiated assessment and disenrollment actions to implement MLTC Policy 13.15 should immediately retract any actions relating to disenrollment. The Department will reissue, in the near future, a policy document which will provide additional guidance and include a date when implementation should occur.
If you have clients threatened with disenrollment that is based on this policy:
Adult Day Care -- NYC Council Bill Would Crack Down on Proliferation of Adult Day Care Centers --By NINA BERNSTEIN (June 6, 2013 - NY Times)
LOMBARDI program --will be closed to new enrollment for dual eligibles in mandatory counties on June 17th. The program was closed to new members with Medicaid only on May 15th. Lombardi participants living in counties that do not yet have mandatory MLTC (all counties outside NYC, Long Island and Westchester) may still stay in the Lombardi program.
Transition rights -- In mandatory counties, the MLTC plan must continue providing the entire plan of care from the Lombardi program for 90 days, using the same providers, and pay the Lombardi program for those services -- including those that the Lombardi program contracted out. This is under MLTC Policy 13.13: Continuity of Care and Payment Requirements of MLTC Plans to LTHHCP Agencies Providing Care During the 90 Day Transition Period - May 30, 2013
Additional resources for MLTSS programs are available in a CMS Informational Bulletin released on May 21, 2013
See Approved Long Term Home Health Care Program (LTHHCP) 1915 (c) Medicaid Waiver Amendment - undated NYS DOH Explanation of which LTHHCP (LOMBARDI) participants must transfer to managed care or managed long term care plans. In summary -
See more on Lombardi and MLTC below under APRIL 2013 NEWS .
On May 8, 2013, the State Dept. of Health released MLTC Policy 13.10: Communication with Recipients Seeking Enrollment and Continuity of Care which attempts to address problems raised by consumer advocates of plans discouraging prospective members from enrolling by telling them that the plan "doesn't provide 24-hour care," that the family must supplement the care privately, etc. These problems were raised by NYLAG, Empire Justice Center, CIDNY, the Legal Aid Society, and other consumer advocates at a meeting with Mr. Helgerson on April 30, 2013, as reported by the New York Times on May 1st.
Policy 13.10 also extends the initial transition period, during which the plan may not reduce services previously received from CASA/DSS/CHHA. This period is now 90 days, extended from the former 60 days.
Social Adult Day Care Update --
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