August Policy and Planning Meeting Includes Updates on Social Day Oversight, Enrollment Lock-In, Independent Assessment, MAP Behavioral Health Carve-In, and Transportation Carve-Out

The monthly Department of Health (DOH) Managed Care Policy and Planning meeting held Aug. 12^th included updates on a number of key managed long term care (MLTC) issues, including a new batch disenrollment of long-term nursing home residents, assessments, involuntary disenrollment, enrollment lock-in, and social day oversight. The slides from the meeting are available here and here. The following are some highlights of the meeting:

• Resumption of In-Person Assessments: The Department is holding firm on its previously announced directive to plans and local social services districts to resume in-person assessments of beneficiaries receiving personal care and Consumer Directed Personal Assistance Services (CDPAS) by Aug. 13^th. There will not be any flexibility granted to allow continuation of telehealth/telephonic assessments. However, if beneficiaries refuse an in-person assessment, plans should continue services and should not disenroll the member. Maximus will be transitioning to in-person assessments in two weeks. DOH will re-evaluate the status of in-person assessments in September.
• Independent Assessment: The independent assessment process will not begin Oct. 1^st. DOH is waiting for Enhanced Federal Medical Assistance Percentage (eFMAP) feedback from the Centers for Medicare and Medicaid Services (CMS), which should be provided within a week or two.
• Physician Order for Community Health Assessments: The recent guidance was intended to revert back to the physician order requirements that were in place prior to the public health emergency (PHE).
• Involuntary Disenrollment: Involuntary disenrollment was suspended during the PHE. Plans may resume involuntary disenrollment only for: (i) Medicaid Advantage Plus (MAP) members who are not enrolled in the affiliated Medicare Advantage/Dual Eligible Special Needs Plan (DSNP); and (ii) members of any MLTC product who moved out of the product's service area and legally changed their address (not members who are just absent). More information about this change is available here.
• End of Lock-In Notices: The MLTC enrollment lock-in for partially capitated MLTC plans was instituted on Dec. 1, 2020. The lock-in period for the December 2020 enrollees will end in December 2021, at which time beneficiaries may change plans without cause. Maximus will mail end-of-lock-in notices on Sept. 4^th notifying members that their lock-in period will end in 60 days. Each month, a similar notice will be sent to members at least 60 days prior to the end of their lock-in period. Please note that enrollees may transfer to a MAP or Program of All-Inclusive Care for the Elderly (PACE) (Medicare-Medicaid integrated plan) at any time.
• Batch Disenrollment of Long-Term Nursing Home Residents: Another batch disenrollment of nursing home residents will be effective Oct. 1^st. This will involve about 2,000 members. Plans are directed to send "intent to disenroll" notices to members by Sept. 1^st. DOH is working on providing plans with a final list of the affected members and asked plans not to send the notices out until they receive the approved final list. After the PHE, DOH intends to handle the disenrollment of long-term nursing home residents the same way it handles other disenrollments, rather than using a batched process.
• Social Day and HCBS Settings Rule Compliance: To ensure compliance with the federal home and community-based services (HCBS) settings rule, DOH will be requiring MLTC plans to oversee the compliance of social adult day programs in their networks. DOH will be issuing guidance in the next few weeks and expects plans to initiate oversight activities in October.
• MLTC Transportation Carve-Out: The transportation carve-out procurement for a management company has been posted on the DOH website. Plans should anticipate a February 2023 start date for the carve-out. The carve-out does not apply to PACE programs.
• MLTC Cost Reports: Plans were reminded that cost reports are due on Aug. 16^th. DOH rejected the request to extend the deadline, even though April 2021 rates have not yet been released.
• Out-of-State Professionals: The executive order that allowed out-of-state providers to practice in New York State has expired with the rescission of the PHE. Accordingly, Medicaid-enrolled providers who bill Medicaid and are not licensed in New York State are being notified that their enrollment is being terminated.
• UAS Data Exchange: The Policy and Planning meeting also included a description of the Uniform Assessment System (UAS) Data Exchange that plans may use to receive community health assessment information about their members. The slides are available here.

DOH staff also noted that information concerning the carve-in of behavioral health (BH) benefits to MAP plans had been distributed to plans via a separate email. They announced a technical assistance webinar on the topic to be held on Aug. 16^th. The information sent via email included:

• BH Guidance for MAP Plans
• BH MAP Readiness Tool: MAP plans must submit requested evidence/documents described in Column D of the tool to demonstrate how they will meet the requirements as outlined in Column C. Documents submitted for each row must be identified in Column E with page number and highlighted language where applicable.
• BH into MAP Attestation: Submission due Dec. 1, 2021. This attestation must be signed by an Officer of the Plan or General Counsel and notarized.
• Exhibit C: Mobile Crisis Services Contracting Status Report Workbook

To demonstrate readiness for the Jan. 1, 2022 implementation, MAP plans will be expected to submit the "BH into MAP Attestation" by Dec. 1, 2021. Beginning Sept. 15^th, MAP plans will be required to submit network monitoring reports to the State on the 15^th of every month. This will include reporting monthly to the Provider Network Data System (PNDS) as well as submission of Exhibit C. MAP plans without an affiliated Mainstream or Health and Recovery Plan (HARP) will need to complete Exhibit C on a monthly basis as described in the BH MAP Readiness Tool.

The New York State MAP Plans BH Billing and Coding Manual will be released shortly. Questions should be submitted to the BHO mailbox.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383