Latest News from DOH on Implementing Managed Care

During the July 19 DOH Managed Long Term Care (MLTC) Implementation Advisory Group call, DOH provided brief updates on the following issues:

Orange and Rockland Counties- CMS approval is pending for the transition to mandatory MLTC enrollment in Orange and Rockland counties.  Announcement letters have been mailed to consumers, but no additional letters will be sent until approval is granted from CMS. This marks the start of the “creep” upstate as outlined in Phase III, which was scheduled for June 2013.  

Long Term Home Health Care Program (LTHHCP) – DOH reported on the number of mandatory letters that have been sent to LTHHCP participants:

May – 540

June – 2,300

July – over 1,000

DOH stated there is still a number of letters that need to be mailed.

Reduction of Split-shift, live-in or reduction in hours by greater than 25 percent - The Bureau of MLTC designed a tool, completed by all MLTC plans, to capture information related to reduction of personal care and consumer directed services greater than 25 percent occurring in the time period November 2012 through April 2013 for all individuals transitioned from fee-for-services programs to Managed Long Term Care (MLTC) plans. This aligns with New York State's Special Terms and Conditions #28 (d).

Certified Home Health Agency (CHHA) – DOH stated there has been a slight delay in sending out announcement letters to CHHA participants regarding the move to mandatory enrollment in an MTLC. DOH reports that more letters will be sent in late August.   

Fully Integrated Duals Advantage (FIDA) program- DOH has been in contact with CMS on a daily basis about this downstate demonstration, focusing primarily on grievances and the appeal process. The goal is to finalize the Memorandum of Understanding  (MOU) by Aug. 1, at which point, we’ll have a better understanding of how the state and CMS will work together on this demonstration.

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