ALP Reform Workgroup Discusses Transition to Managed Care

The Department of Health (DOH) held a meeting of the Assisted Living Program (ALP) reform workgroup last week. LeadingAge NY serves on the workgroup and has member representation on the group as well.

Concern was raised in the workgroup regarding DOH’s timeframes for transition of the ALP into managed care and managed long term care (MLTC). At the last meeting, the Department announced a delay of the transition date to July 1, 2017 for downstate counties and Oct. 1, 2017 for the rest of the state. Managed care plan representatives and other workgroup members suggested a further delay of the transition date to Jan. 1, 2018 for downstate and July 1, 2018 for the rest of the state to address concerns around ALP reimbursement and provider/plan readiness.

DOH is recommending rate protection for one year, meaning a managed care plan could not pay an ALP less than the ALP fee-for-service Medicaid rate for one year following the selected transition date. Workgroup members suggested a longer rate protection period. DOH is also discussing the development of a more formal Medicaid cost report for the ALP. Work must be done to determine how plans will transition the current rate structure – which involves a separate ALP rate for each case-mix category – to a workable construct under managed care arrangements. DOH will set up a separate finance workgroup of this group to figure out the reimbursement issues.

There was some discussion of rationalizing the overlapping requirements between ALP and managed care plan for completion of the Uniform Assessment System (UAS) to minimize assessments and redundancy.

Expansion of the ALP program was also discussed, since many counties in the state do not have adequate ALP capacity to ensure network adequacy for plans. The possibility of an ALP need methodology or needs-based process for expanding capacity was suggested in lieu of further competitive solicitations.

Lastly, there was a brief discussion on the federal home and community based settings rule and the impact it has on the ALP. Given the incoming federal administration, it is possible that there could be changes in the rule.

DOH officials indicated that they would discuss the ALP reform workgroup recommendations internally and advise the group of their determinations in the near future. LeadingAge NY will continue to be actively engaged in these conversations to help ensure that the transition of the ALP benefit and population works well for our members and the people they serve.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828