2016-17 MLTC Rate Development Discussion

The Department of Health (DOH) and Mercer, the state’s contracted actuarial firm, held a meeting on Sept. 21, 2016 to review 2016-17 Medicaid Managed Care and Managed Long Term Care (MLTC) rates. The handouts provided at the session may be accessed here:

The MLTC rate review included presentations from Mercer staff on developing the risk score and calculating the minimum wage adjustment as well as rate development presentations from both Mercer and DOH. Presentations were informed by questions submitted in advance by plans and associations. A number of concerns regarding the nursing home component of the rate and network narrowing were expressed, but due to time limitations, DOH deferred discussion of these issues to a dedicated meeting to be scheduled shortly.

Highlights from the MLTC part of the meeting are presented below.

Data from 25 of the 39 MLTC plans and PACE programs representing 123,800 enrollees and participants were included in the development of this year’s risk model (up from 93,000 last year);
While a small number of nursing home residents are included in the model, nursing home residents enrolled in plans due to mandatory transition to managed care are not;
Although the model development analysis led to a number of changes in the points associated with predictors included in the model (see table on p. 12 of Risk Adjustment presentation), the year-to-year change in risk score attributable to these changes was within half a percentage point for most plans (ranging from a 2.4 percent decrease to a 3.4 percent increase);
Participants pointed out the difficulty in managing around the unpredictability of risk score changes and requested greater participation, including plan clinician involvement, in the model development process in the future. Mercer and DOH were amenable to this, and reported that they were working on being prospective in this area and plan to make dashboards with encounter data available to plans to provide quicker insights on this;
Mercer expressed an interest in including nursing home residents in the risk adjustment but suggested that this would replace the nursing home add-on as well as high-cost nursing home price mitigation pool;
In the future, the state is seeking to make program risk adjustments to reflect differences in acuity of MLTC, FIDA, PACE, and MAP enrollees (as they did with MLTC and FIDA this year);
Plans wanting to validate their risk score calculation can obtain a list of the enrollees whose UAS data was included in the calculation by emailing a request to mltcrs@health.ny.gov;
Mercer reviewed the calculation for adjusting rates to reflect wage parity and minimum wage increases for personal care and home care services in the NYC area. DOH reiterated the expectation that aggregate dollars provided to meet wage mandates be passed through to providers;
Adjustments to reflect minimum wage increases for home care/personal care workers will be included in the October 2016 rate update. Minimum wage adjustments for other services will be made in the January 2017 rate update;
Although Mercer indicates a -6.93 percent managed care efficiency adjustment in NYC when calculating actuarial rate ranges, this adjustment is NOT applied to the payment rates;
The total statewide rate change from April 2015 to April 2016 was a 4.1 percent increase, but varied by region. DOH is examining some regions to understand why the community portion of the rate in NYC remained flat and dropped 3.24 percent in Region 3.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841