As described in this article, most adults in NYC, Westchester, Nassau and Suffolk counties who have Medicaid and Medicare, who are receiving Medicaid home attendant or housekeeping ("personal care") services through their local Medicaid "CASA" office, or long-term CHHA or adult day care services, must select and enroll in a managed long term care plan, or a PACE or Medicaid Advantage Plus plan. If they don't select one within 60 days of receiving an enrollment letter from New York Medicaid Choice, they will be assigned to a "partially capitated" managed long term care (MLTC) plan. (See more information on the enrollment process)
The information they will receive -- Links to the information consumers are receiving from New York Medicaid Choice is in this article, including the following:
Official Guide to Managed Long Term Care, written and published by NY Medicaid Choice (Maximus) - note - consumer advocates had the opportunity to review a very early draft of this guide months ago, but never had the chance to review or see the guide again until today)
Statewide Plan contact list (NYS DOH site), and Statewide version of contact list adapted by Selfhelp
http://www.nymedicaidchoice.com/program-materials - See Long Term Care plans - separate lists for NYC, Nassau-Suffolk, and Westchester, Hudson Valley, with separate list for each of the 3 types of plans - MLTC/MAP/PACE
See HRA NYC chart showing MLTC plans including MLTC, MAP, and PACE as well as Medicaid Managed Care, Medicaid Advantage, and Special Needs plans. Has eMedNY codes
NYC Chart organized by insurance company, showing which different MLTC/MAP/PACE plans are offered by the company as of Dec. 2013 .
Medicare Advantage plans and enrollment in NYC, along with MLTC/MAP/PACE and MEDICAID ADVANTAGE plans offered by the same company as of Feb. 2013 -
Statewide chart by COUNTY showing MLTC/MAP/PACE plans with current enrollment as of December 2013-- Enrollment statistics are updated monthly by NYS DOH here -- Monthly Medicaid Managed Care Enrollment Report
Medicare Advantage plans and enrollment in counties outside NYC, along with MLTC/MAP/PACE and MEDICAID ADVANTAGE plans offered by the same company as of Feb. 2013 -
If the consumer does not select a plan, they are randonly assigned to a plan. Even if New York Medicaid Choice helps them pick a plan, we understand that the sole criterion NY Medicaid Choice will use in plan selection is the plan network of providers -- this company will have access to an internal database showing all of the networks of providers in each plan, so that it can recommend a plan that contracts with the providers of the client's choice.
Here is other information that may be helpful in selecting a plan.
All MLTC plans are required to report certain quality data to the State. The State posts reports each year at this link. including some results of customer satisfaction surveys conducted by the Dep't of Health. These data for have been summarized on the DOH website, and may help consumers comparing different plans:
Please note that consumer advocate have criticized the State's reports for lacking important information that is necessary for consumers to make an informed choice about plans. See New York’s 2012 Managed Long Term Care Report: An Incomplete Picture (April 2013) -- The Coalition to Protect the Rights of New York’s Dually Eligible issued this "Incomplete Picture" Report as a critique of the NYS Dept. of Health's 2012 Managed Long Term Care Report, issued in December 2012. The State's Report does not provide the full spectrum of information that beneficiaries need to make informed health care choices -- For example, The 2012 Report presents the most favorable findings of consumer surveys, but fails to mention less positive but important findings from IPRO’s report, including the fact that higher need respondents in poorer health were significantly more likely to raise concerns about services than those in good health. The Report fails to include any meaningful utilization data, showing the amount of and type of services provided by MLTC plans or the medical-loss ratios of the various plans. The Report fails to comply with the Public Health Law that requires the report to present information in a way that allows beneficiaries to make meaningful comparison between plans. Inadequate quality data is reported as well.
The State's Q & A issued Aug. 21, 2012 states:
Q39. How do new Medicaid applicants enroll into MLTC? Can they be assessed by multiple plans prior to enrolling or must they enroll in order to get assessed for services?
A39. Consumers new to service must be assessed prior to enrollment. Consumers may contact multiple plans and request assessment, however, services will not be provided until they are enrolled in a plan.
Q44. In mandatory enrollment zip codes, if a consumer contacts a plan to see options during the 60 day period, if a plan conducts a visit, is the consumer entitled to a written plan of care before the enrollment?
A44. The plan is responsible for issuing a written plan of care.
Through Freedom of Information requests, data has been released that the Evelyn Frank Legal Resources Program, now part of New York Legal Assistance Group, has analyzed. Click here for data from 2010 and 2011 showing charts that compare the amount of home care hours plans provided to their members in 2010 and 2011, the medical loss ratio of various MLTC plans (percentage of premium spent on care vs.administrative overhead), and other data.
An analysis completed by the Center for Independence of the Disabled NY (CIDNY) found MLTC Plans out of compliance with ADA requirements. See Letter to Mark Kissinger, Dep. Commissioner NYS DOH, dated Oct. 5, 2012, from Susan Dooha, Exec. Director, CIDNY, posted at http://tinyurl.com/CIDNY-MLTC-ADA, referencing Chart Comparing MLTC ADA Plan Compliance, posted at http://tinyurl.com/CIDNY-MLTC-ADA-chart-xls.
One important factor in choosing a plan is whether you can keep your aide that worked with you when CASA/DSS or a CHHA authorized your care before you enrolled in the MLTC plan? Statewide, the new MLTC plan is required to contract with all home attendant/personal care agencies, certified home health agencies, Lombardi programs, and other care providers that previously had contracts with the local Medicaid program, at least through March 1, 2014. See Final Continuity of Care Policy for Managed Long Term Care. This policy is intended for them to be able to keep the same aide they had in the CASA program. If they learn that the assigned MLTC plan does not contract with their current home attendant or home care vendor, they should ask the MLTC plan to do so so that they can keep their aide. Cite the above policy. If the MLTC plan refuses to allow the client to keep her aide, call the State Dept. of Health at 1-866-712-7197 (MLTC Complaint Line).
The State has clarified that this “continuity” policy will be required in other areas of the State through March 1, 2014. See:
MLTC Policy 13.12: REVISED Personal Care Contracting (thru 12/31/13)
MLTC Policy 13.22: Personal Care Contracting Rates (thru 3/1/2014 in NYC, Long Island & Westchester)
For people receiving CDPAP consumer-directed services, the requirement that all plans contract with the local CDPAP vendors goes through 10/31/13 so consumers can keep their current aides. See Policy for the Transition of Consumer Directed Personal Assistance Services into Managed CareHowever, as a practical matter, not every plan has entered contracts with every single home attendant vendor in NYC.
Despite requests from advocates, the State has not made publicly available any online listing of provider networks. While NY Medicaid Choice has access to some internal database, this is not being made public. The only public information is that posted on the plan's own websites or that the plan will mail you upon request. To help you identify networks, we have compiled information to the extent available as of July 2012.
The MLTC Model Contract requires the MLTC plan to "...have a minimum of two (2 ) providers that are accepting new Enrollees in each county in its service area for each covered service in the benefit package unless the county has an insufficient number of providers licensed, certified or available in that county as determined by the Department.
4. Providers of covered services to which an Enrollee must travel must be geographically accessible for the enrolled population. Travel times must not exceed:
a. Thirty (30) minutes from the Enrollee’s residence in metropolitan areas;
b. Thirty (30) miles from the Enrollee’s residence in non-metropolitan areas.
5. If the Contractor is unable to provide necessary services through its contracted network for a particular Enrollee, the Contractor agrees to adequately and timely furnish these services outside of the Contractors’ network for as long as the Contractor is unable to provide them within the network
DOH Model MLTC Contract, Article VII Part D (p. 46)
Look at whether your other providers are in the plan's network. For example --
WHAT NURSING HOMES ARE IN MY PLAN'S NETWORK? -NYLAG is beginning to compile charts to compare networks of plans from the directory information listed below. The first type of provider network compiled is for NURSING HOMES covered by each plan.
Q42. As discussed on the MLTC weekly call, can you please confirm that the following assertions are true, and if not, please clarify the policy on the following: (1) MLTC plans must pay the member’s Medicare coinsurance for skilled in-patient rehabilitation services provided in an SNF, regardless of whether the facility is in the MLTC plan’s nursing home network.
A42. Yes, Managed Long Term Care plans must pay the member’s Medicare coinsurance for nursing facilities.
NOTE - However, after the Medicare coverage ends, MLTC plan may decline to pay for nursing home care unless member transfers to an in-network nursing home. The MLTC plan must cover the cost of care pending a reasonable period to transfer. Q&A dated Aug. 16, 2012 Q&A No. 49.
Click here for a tool for seeing the severity of deficiencies for nursing homes. It has free text capability as well.
The link is set for New York and the nursing homes with the worst deficiencies. This is from ProPublica, a public interest journalism site. Thanks to Public Signals for this useful link.
Mandatory Managed Care in New York State Nursing Homes - A Review and Assessment of Current Access & Quality as the State Mandates Medicaid Managed Long Term Care for Nursing Home Residents - Report of the Long Term Care Community Coalition of NYS, using federal and state data. (Dec. 2013)
Click here for Nursing Home Compare, a federal database allowing comparison of nursing homes by quality measures, staffing, and deficiencies.
2013 Nursing Home Quality Pool (NHQP) scores - a State initiative to compute an equitable quality scoring system using existing data sources. The NHQP score is comprised of fourteen quality performance measures, three compliance measures and one efficiency measure. The Department of Health assessed each nursing home on their performance in all areas of the NHQP as compared to their peers. Determinations of fraud or abuse by the Attorney General’s office or specific deficiencies cited during the survey process were also incorporated into the results. In January 2014, the State released the ranking of the NHQP scores by quintile; the payment of the 2013 NHQP is pending CMS approval. The NHQP excludes non-Medicaid, CMS Special Focus Facilities, Specialty-Only Facilities, Continuing Care Retirement Centers, and Transitional Care Units.
In addition to a plan’s network of dental providers, MLTC recipients as well as mainstream managed care members have the right to access dental services at Academic Dental Center clinics licensed under article 28 of the NY Public Health Law. N.Y. Pub. Health Law § 4403-f(7)(b)(vii)(D) (MLTC statute expressly incorporating Medicaid managed care requirements at N.Y. Soc. Serv. § 364-j(4)(a)(iii)(D)).
There are five dental centers in New York State that meet these criteria. They are:
Under the Model MLTC contract, dental services at these clinics may be accessed without prior approval and without regard to network participation. Plan must reimburse at reimburse the clinic for covered dental services provided to enrollees at approved Medicaid clinic rates. See Article VII(H)(1) at page 48 of contract. See also MAP Model Contract, at § 22.12(a); PACE Model Contract, at Art. V(L)(c)(sic).
Like dental care, optometry services provided by Article 28 clinics affiliated with the College of Optometry of the State
University of New York may be accessed directly by Enrollees without the Contractor’s prior approval and without regard to network participation. Model MLTC contract Article VII(G)(1) at page 48. NYLAG will post list of these clinics soon. Main clinic is
University Eye Center - also offers Homebound visits
SUNY College of Optometry
33 West 42nd St
New York, NY 10036 Phone: (888) 277-5666 or (212) 938-4001 Pre-register using our Online Appointment Form
|PLAN||How info available||Phone||Notes|
|AgeWell New York||Directory online||866-586-8044|
|Aetna Better Health||1-855-456-9126|
|ArchCare Community Life||Directory online||866-263-9083||Click here for Member Handbook in English & Spanish, with Westchester version|
|Directory online - searchable database||877-226-8500|
|Centers Plan for Healthy Living||Directory online||855-270-1600|
|Extended MLTC||NO WEBSITE AS OF 11/22/13|
|Fidelis Care at Home||Searchable database online (select "Fidelis Care at Home," note if provider accepting patients||800-688-7 422||Must search for particular provider types, no full single directory available.|
|HealthPlus MLTC (Amerigroup)||Directory online||800-950-7679|
|HHH Choices Health Plan||Directory online||866-663-6877|
|HIP MLTC||888-447-4838||Caution not to get networks for other HIP Medicaid managed care plans|
|Independence Care System||Directory online||877-427-2525|
|Integra MLTC||no directory online||1-855-800-4683||Member handbook in English, Russian and Spanish|
|MetroPlus||MLTC Provider Directory||
855-355-MLTC(6582) (TTY: 1-800-881-2812).
|North Shore-LIJ MLTC||(855) 421-3066||Member handbook|
|Senior Health Partners||Call for directory. Selfhelp obtained in August 2012 and uploaded here.||800-633-9717|
|Senior Whole Health MLTC||Directory online (direct link) or through this webpage||
|United Health Personal Assist||1-877-512-9354|
|VillageCare Max||Directory online.||800-469-6292|
|VNSNY Choice MLTC||Directory online||888-867-6555||Revised May 2012|
|WellCare Advocate MLTC||Directory online||866-661-1232||Updated once/year - call for more current info|
MEDICAID ADVANTAGE PLUS
|Plan Name||How Network Info Available||Phone Number||Member Handbook and Additional Notes|
|Elderplan, Inc.||866-386-9437||Elderplan materials available here.|
|888-447-9161 TDD 888-447-9161|
|Fidelis||Searchable database online (select "Medicaid Adv. Plus," note if provider accepting patients||877-533-2404||Must search for particular provider types, no full single directory available.|
|Guildnet Gold, Inc.||Network info online here - scroll down to Provider & Pharmacy Directory and click on borough of choice||800-932-4703 or 800-815-0000||Member handbook available here.|
|HealthFirst Complete Care||Doctors and hospitals are http://www.healthfirstny.org/our-network-doctors.htmlonline, but not any other services. Presumably LTC services network is same as Senior Health Partners, affiliate MLTC plan.||888-260-1010|
|HealthPlus, an Amerigroup Company||Doctors and other medical providers in MAP plan online here. Long term care does not appear to be online||866-805-4589||Member handbook available here.|
|Senior Whole Health M/M Plus||Directory online for some plans, but says to call for additional info about provider availability for Medicaid Advantage Plus||877-353-0185||Member handbook available here.|
|VNSNY CHOICE Total||Directory online for Total plan as of 2/2013. See info on networks here.||866-597-6674||Member handbook available for download here.|
|WellCare Advocate Complete||Directory online, but shows network for various Medicaid & Medicare plans, and cautions that some benefits vary by plan.||866-661-1232||Evidence of Coverage available here.|
|Plan Name||How Network Info Available||Phone Number||Member Handbook and Additional Notes|
|ArchCare Senior Life||
|Centerlight Healthcare PACE||Directory online for NYC, Nassau, Suffok & Westchester||877-226-8500||Member rights listed here.|