Where is Managed Long Term Care Headed This Month?

Mandatory Managed Long Term Care (MLTC) enrollment continues to move into other parts of the state.  Announcement letters to consumers enrolled in personal care, Consumer Directed Personal Care Assistance Program (CDPAP) and Adult Day Health Care (ADHC) went out in Long Island and Westchester.  Letters for individuals residing in those areas receiving private duty nursing or long term services from a Certified Home Health Agency (CHHA) have been delayed, however, due to some glitches. Maximus has also mailed announcement letters to ADHC and private duty nursing cases in NYC not enrolled under personal care case activity.

As of 12/31/2012, 20,306 announcement letters have been mailed.  As of 1/31/2013, 381 people accepted auto assignments for an effective date of 1/1/2013, and 125 accepted auto assignments for an effective date of 2/1/2013.  There was noauto assignment in December due to Super Storm Sandy. The state has contracted with IPRO to provide a report on people who are auto-enrolled in MLTCs; however there is limited information for analysis at this time.

DOH is looking to implement an Ombudsman in MLTC similar to the model currently used in Wisconsin.  DOH is also considering modeling a quality pool for MLTCs after the quality pool for managed care organizations.  Lastly, personal care rates after March 31 of this year are still under discussion.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, or Cheryl Udell, cudell@leadingageny.org, 518-867-8383