FLSA Funding and Expansion of MLTC Benefit Package Detailed at DOH Managed Care Meeting
The monthly Managed Care Policy and Planning meeting between the State Department of Health (DOH) and Medicaid managed care plans included, among other items, an update on pending Managed Long Term Care (MLTC) rate packages; a briefing on the distribution of funds to cover increased costs associated with the new Fair Labor Standards Act (FLSA) regulations; and a discussion of the Governor’s proposal to expand the MLTC benefit package to include all Medicaid benefits. The agenda and presentations from the meeting relevant to long-term/post-acute care providers and plans are available here, here and here.
MLTC and Other Long Term Managed Care Rate Packages
DOH discussed the status of various rate packages, including, among others, the following:
- 2015 MLTC Phase II rates: The 45-day Center for Medicare and Medicaid Services (CMS) review period has expired, and the rates are awaiting State Division of Budget (DOB) approval.
- 2015 MLTC Phase III Rates: A draft rate package was released on Feb. 10th, which includes the adjustment for July-Sept. nursing home enrollment, based on data collected through the nursing home resident enrollment survey. This rate package will be sent to CMS in early March, at which time the 45-day clock for CMS review will begin to run. DOB approval will be needed before the rates can be paid.
- MLTC FLSA State Share Advance: The State share advance on the FLSA adjustment will be paid to plans on March 2nd, outside of the scheduled rate package.
- 2015 MLTC Phase IV Rates: This rate package includes adjustments for the 13-hour live-in rule, Oct.-Nov. nursing home enrollment, and the State and federal shares of the FLSA adjustment. A draft package will be released in March and be can be submitted to CMS 30 days later. The rates can be paid once the 45-day CMS review period has expired and DOB approval is received.
- 2015 PACE Phase I and II Rates: These packages are being finalized, based on data validation and resubmissions, and will be released this week.
- PACE and MAP FLSA State Share Advance: This adjustment is expected to be paid to PACE and MAP plans by the end of Feb.
DOH indicated that it will be repeating its survey of MLTC nursing home enrollment in late Feb., for use in the Phase V update of rates. Plans expressed concern that the nursing home enrollment figures included in the draft Phase III rates do not include residents whose financial eligibility for institutional budgeting is pending or who have an R/E code of N7. DOH agreed to follow up on this issue.
DOH also announced that CMS has approved an increase in the Medicare A/B portion of the FIDA rates ranging from 5.7 to 10.4 percent based on deficiencies identified in CMS’s risk adjustment model for dually-eligible beneficiaries. This adjustment will be effective retroactive to Jan. 2016.
FLSA Funding
DOH announced in the fall that it would adjust MLTC rates by 34 cents per personal care hour to compensate for changes to compensation requirements under FLSA regulations for overtime, travel time, and live-in services. In last week’s meeting, DOH explained that the FLSA adjustment is being made as an adjustment to MLTC base rates, based on a unit cost of 34 cents per hour, risk adjusted for each plan. Risk adjustments are being made based on the Phase IV risk scores. In the 2016-17 rates, the FLSA adjustment will be based on provider data reporting.
DOH stressed that the initial FLSA adjustment will include the State share only, reflecting a six-month adjustment. Once the federal share is approved, DOH will recoup the State share advance and pay out the full amount.
Plans sought additional guidance on the mechanism for distributing the funds and the supporting documentation required. DOH staff indicated that guidance in the form of “questions and answers” would be released at the same time as the State share advance. Plans and providers are encouraged to submit their questions as soon as possible to: flsa@health.ny.gov.
For providers delivering personal care on a fee-for-service basis (i.e., not through a managed care contract), the per hour amount will be factored into rate adjustments, effective Oct. 13, 2015.
MLTC Benefit Expansion and Medical Loss Ratio Proposals
The Department clarified that its budget proposal to expand the MLTC benefit package would extend beyond behavioral health benefits to the entire Medicaid benefit package, including physician services and acute care. Medicare would remain the primary payer for Medicare covered benefits, while Medicaid would remain secondary. MLTC plans would have to create networks for all Medicaid benefits for non-dually-eligible members. They would also have to develop mechanisms to “wrap around” the Medicare benefits for dual eligible. This clarification raised numerous questions by plans. LeadingAge New York is seeking additional information on this proposal.
NHTD-TBI Transition to Managed Long Term Care
The Department announced that it is continuing to convene meetings on the transition of beneficiaries in the Nursing Home Transition and Diversion Waiver and Traumatic Brain Injury Waiver to MLTC plans. It is encouraging plans to participate in these meetings. The next meetings will be held Feb. 19th and Feb. 24th. A draft transition plan will be released to the public for comment on April 1. Questions for DOH concerning this transition should be sent to waivertransition@health.ny.gov.
Community First Choice Option
These home and community-based services for the nursing-home-eligible population will be added to the MLTC benefit package beginning in Jan. 2017.
Telehealth Regulations
The Department is still reviewing the draft telehealth regulations discussed at the Dec. meeting and did not provide a timeframe for publication. It is preparing a Medicaid State Plan Amendment to add remote patient monitoring and store and forward technology to our State Plan benefits.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.