Comments to DOH on the NHTD/TBI Draft Transition Plan

LeadingAge NY submitted comments to the Department of Health (DOH) on the “draft” Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury Medicaid waivers transition plan into managed care.

We discussed in our comments how the NHTD and TBI participants are part of a well-defined and unique population that is well-served by the current waiver infrastructure, with built-in assurances for budget neutrality even though this population has a greater tendency for high medical, psychological, and social needs. Members have expressed concern that if the NHTD and TBI participants are enrolled into managed care, they would face a greater likelihood of being hospitalized, institutionalized, or incarcerated given their significant need for wrap-around services and supports that are currently provided but are lacking in the managed care infrastructure. Nevertheless, assuming that the transition to managed care moves forward, LeadingAge NY members insist that the program features must be substantially comparable to those services available to NHTD and TBI participants since January 2015. We discussed that if the transition is to take place by January 2018, numerous components to the transition plan need to be addressed.

A brief summary of the major components is below:

• More detail is needed on how the Community First Choice Option (CFCO) new State Plan Amendment (SPA) will be implemented. Without this, the intersection of the CFCO with the waivers and managed care is unclear, and the potential impact cannot be assessed.
• It is critical to understand how the Home and Community-Based (HCB) Settings rule will be implemented in New York. Comments on this rule are due to DOH next month. An understanding of how “conflict of interest” and “heightened scrutiny” will be applied is critical to understanding the impact of the transitioning of the two waivers into managed care.
• For waiver participants, providers, and managed care plans to effectively prepare for the transition, more specific timeframes and procedures are needed. DOH should articulate specific and realistic timeframes and procedures for the transition of both waivers to managed care plans similar to past Medicaid Redesign Team (MRT) proposals.
• Change in definition of Home and Community Support Services (HCSS) – our recommendation was given that the service needs of this vulnerable and diverse population can be significantly greater than those of a personal care population, it would be in the participants’ best interest to maintain the current HCSS definition.
• Location of the enhanced benefit – Structured Day Program (SDP) – our recommendation was that Structured Day Programs must be required to follow the same regulations and policies applied to the Social Adult Day Care (SADC) Program or the Adult Day Health Care programs as a result of any heightened scrutiny provisions developed under the HCB Settings rule.
• Service Coordination – we are concerned with the usage of DOH’s plan as it relates to “business relationship,” as it is overly vague and will cause significant confusion.
• Role of the Regional Resource Development Center (RRDC) – as stated in the draft transition plan, "the RRDC will continue to have a role in the managed care model. In order to access the enhanced benefits noted above, NYSDOH will continue to contract with RRDCs." It is our suggestion that the current RRDC role be extended for two years, similar to the continuity of care provisions. During this time, DOH could track how many referrals were made for enhanced services to see if there is a need for this role and to what degree.
• Assessment Tool – UAS-NY – The MLTC/MMC plans will be using the UAS-NY to assess NHTD/TBI individuals. LeadingAge NY concurs with the concerns and suggestions raised by The Alliance of TBI & NHTD Waiver Providers and other stakeholders during the NHTD/TBI transition meetings regarding the concerns with using this assessment tool with participants who are cognitively impaired.
• Tracking Waiver Participants through the Transition Process – our recommendation included that DOH should consider developing metrics and a process to track positive and negative outcomes as result of this transition to managed care. This should include any changes in services and any incidents of participants being hospitalized, incarcerated, or institutionalized.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871