MLTC UPDATE Sept. 2018 Guildnet to Close Jan. 1, 2019; UnitedHealth MLTC closing upstate; MLTCs must cut number of home care agencies

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

 Please see archives for past articles:

KEY CONTACTS

September 2018 Update -

1.    Upcoming Training & CLE  Program on Managed Long Term Care - Nov. 14, 2018 at the New York Academy of Medicine. Click here for registration information.   Conducted by NYLAG Evelyn Frank Legal Resources Program

2.   The NYS Dept. of Health has confirmed that GUILDNET will  CLOSE in JANUARY 2019; UnitedHealthCare is pulling out of 4 upstate counties in February 2019:

ALBANY 103
BROOME 266
ERIE 181
MONROE 534
ONEIDA 91
ONONDAGA 288
Total 1,463

3.   POLICY ISSUED IMPLEMENTING restriction on the number of Licensed Home Care Services Agencies that an MLTC plan may contract with, beginning Oct. 2018.  

August 2018 Update

July 2018 Update

March 27, 2018 update

February 28, 2018 update

​December 2017 Update

October 26, 2017 Update on Home Care Worker Pay issues

An update to the news below about the recent NYS Appellate Division decisions that allow lawsuits to go forward by home care aides challenging a 2010 NYS Dept. of Labor policy that allows live-in aides to be paid only 13 hours/day.  The courts found that the 2010 policy  is contrary to the state labor regulations that require that the minimum wage be paid for every hour worked, unless the worker actually resides in the consumer's  home.

On Oct. 25, 2017, the NYS Dept. of Labor published an "emergency regulation" (p. 5 of link) that amends the NYS minimum wage regulations in a way that appears to attempt to undermine the recent appellate court decisions.  Those decisions found that the 2010 NYS Dept. of Labor policy RO-09-0169 Live-In Companionsthat  allowed live-in aides to be paid 13 hours for a 24-hour day, if they do not actually live with the consumer, conflicted with the actual state minimum wage regulations.  Now the State amended the minimum wage regulations to state that live-in aides need not be paid for the 3 1-hour meal periods and 8 hours of sleep time (totaling 11 hours/day) that are excluded from hours worked under the federal minimum wage regulations as amended by the Obama administration.  The amendments appear to be intended to adopt the 2010 policy guidance  RO-09-0169 Live-In Companionsand allow payment of 13 hours/day..  If the Court of Appeals accepts review of the Appellate Division cases, the impact of the regulatory amendments will no doubt be disputed.  In the meantime, it is not clear what is the impact of the amendment to the regulations.  See consumer advocacy tips below if consumer's 24-hour shift is not staffed adequately by an MLTC plan or managed care plan.   

August - October 2017 Update

MLTC Plan Closings Update 

The new MLTC Policy 17.02 procedures will be used for Guildnet and North Shore LIJ Closings described below.

Two New FIDA Plans Launched in Westchester, while 5 FIDA Plans Slated to Close in 2018 

When FIDA first expanded outside of New York City and Nassau counties to Westchester and Suffolk, only one plan -- Agewell FIDA -- was offered in those counties.  Two new FIDA plans  are available in Westchester County (since 7/1/17) -- Healthfirst and Riverspring.  Agewell remains the only plan available in Suffolk.  See complete list of FIDA plans , but note that the list will change in 2018 when these 5 FIDA plans close: Aetna, Guildnet (in Nassau County only), Fidelis, ICS, and North Shore -LIJ, 

Home Care Aide Wages - Court Decisions, Wage Parity and Minimum Wage increases - 

The million (or billion?) dollar question is how State will fund the additional pay for live-in workers in MLTC, mainstream managed care, CHHA, and in fee-for-service home care authorized by local Medicaid districts as "immediate need" services or for people excluded or exempt from MLTC or managed care.   Consumers are seeing ripple effects of the ruling in home care agencies refusing to accept new "live in" cases.   While rulings may be appealed, the decisions are not "stayed" and are arguably the binding interpretation of the law in NYC and the entire metro area covering about 12 other counties.  
Meanwhile, it remains difficult for consumers to obtain authorizations from MLTC plans for split shift or 2-12 hour shifts/day, despite helpful clarification of the standard for split shift "continuous" care  in state regulations, and despite helpful MLTC Policy 16.07.   See more on standards for assessing and authorizing personal care here. 
October 26, 2017 Update - See above for news about change in state labor regulations published Oct. 25, 2017. 
ADVOCACY TIPS --  Members of MLTC  or other managed care plans can file a grievance with your MLTC or managed plan and file a complaint with the NYS Dept. of Health  if you are authorized for 24-hour live in care but the MLTC or managed care plan cannot find an agency to staff the case.     

MORE TIPS:  Also, consider whether your needs may meet the standards for 2x12 split shift care, and request the plan to increase your services.  Call ICAN for help or guidance. 

Heads Up re Assisted Living Program (ALP) and MLTC - The Assisted Living Program is expected to be "carved into" MLTC and Mainstream MMC, effective 10/1/18 for NYC, Long Island and Westchester, and effective 1/1/19 for the rest of the state.  This means plans will now authorize and pay for ALP services, as they do nursing homes.  Exact procedures are unknown, but we presume that current ALP residents will be "grandfathered in" as nursing home residents were grandfathered in when the nursing home benefit was carved into MLTC.  See this article and MRT 1458

U.S. Office of Inspector General releases report,  "New York State Improperly Claimed Medicaid Reimbursement for Some Managed Long-Term Care Payments" (A-02-15-01026) -   

From executive summary:

New York improperly claimed reimbursement for 36 of 100 payments made to Medicaid Managed Long-Term Care (MLTC) plans. Specifically, New York did not ensure that MLTC plans documented eligibility assessments of program applicants and reassessments of those already in the program, and conducted these assessments in a timely manner. New York also did not ensure that the plans provided services to beneficiaries according to a written care plan. Further, New York did not ensure that the plans enrolled and retained only those beneficiaries who required community-based services, and disenrolled beneficiaries who requested disenrollment in a timely manner.

In addition, CMS physicians found that for 71 beneficiaries associated with the payments we reviewed, the beneficiaries' MLTC plans did not comply with New York's contract requirements for service planning and care management.

May 2017 UPDATE

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

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21 Sep, 2018
MLTC UPDATE Sept. 2018 Guildnet to Close Jan. 1, 2019; UnitedHealth MLTC closing upstate; MLTCs must cut number of home care agencies
http://www.wnylc.com/health/news/78/