News on Conflict-Free Case Management

Mark Kissinger, Director of the Division of Long Term Care at DOH shared important news at the LeadingAge NY Annual Conference last week regarding Managed Long Term Care (MLTC) and its impact on home and community based services.

During his PowerPoint presentation, he provided the latest MLTC numbers as of May 1, 2013:

Statewide Enrollees in MLTC: 101,080

NYC: Partial Cap: 86,702, PACE: 3,219, Medicaid Advantage Plus: 3,767 = 93,688
Rest of state: Partial Cap: 5,663, PACE: 1,550, Medicaid Advantage Plus: 179 = 7,392
Total: Partial Cap: 92,365, PACE: 4,769, Medicaid Advantage Plus: 3,946 = 101,080

DOH also provided more information regarding a discussion happening at the federal level regarding the definition of home and community-based settings. The Centers for Medicare and Medicaid Services (CMS) has been grappling with how these settings should be defined for the purposes of receiving Medicaid-covered long term services. Issues such as privacy, consumer choice and access to kitchen and dining areas are under consideration.

Mr. Kissinger also reported that there are major changes to come as a result of negotiations with CMS. Slide 10 and 11 of his presentation highlight some of these changes. DOH is in the process of developing a plan for approval from CMS to implement the following:

Begin implementation of an independent and conflict-free LTSS needs assessment system no later than Dec. 1, 2014.
After that implementation has begun, MLTC plans will not complete any LTSS needs assessments for individuals requesting such services prior to the enrollment in the plan.
Non-dually eligible individuals requesting LTSS will be assessed to see if they meet the criteria to be enrolled in a MLTC plan or alternate waiver program prior to being told their enrollment options.

This discussion raised questions about how Care Management Administrative Services (CMAS) contracts would be affected. Kissinger responded that this is a "work in progress" and welcomed our suggestions. Presently nine CMAS contracts are under review and four more have been submitted for a total of thirteen.

Lastly, it was confirmed that the spousal impoverishment rules shall apply to individuals who have a spouse living in the community who enrolls in the MLTC program.

LeadingAge NY will keep members informed of new developments. We have already requested to be part of discussion on how conflict-free case management will unfold in relationship to CMAS and the Balancing Incentive Program (BIP).

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