Highlights of March Managed Care Plan Meeting

The monthly meeting of Medicaid managed care plans with the Department of Health (DOH) covered a wide variety of issues from mainstream plan rate development to Delivery System Reform Incentive Payment (DSRIP) program updates. Of particular interest to long-term/post-acute care providers and managed long-term care (MLTC) plans were discussions concerning Fair Labor Standards Act (FLSA) payments, QIVAPP payments, and the status of rate packages. The MLTC-FIDA update slides from the meeting are available here.

FLSA

DOH staff addressed questions concerning the FLSA payments to MLTC plans released earlier this month. They stressed that the funds must be used for the benefit of the worker to cover additional overtime and travel time expenses incurred as a result of the implementation of the new FLSA regulations. These payments cannot be used to cover expenses associated with reducing overtime expenses, such as recruitment and training expenses.

Plans are required to develop reasonable methodologies for allocating these payments among the home care agencies in their networks and must report these methodologies to DOH. Any of the methodologies outlined in the DOH “Frequently Asked Questions” (FAQs) document would be considered reasonable. The discussion included the appropriate action to take in the event that the funds received by the plan exceed the amount to be allocated to agencies based on the plan’s distribution methodology. DOH indicated that it will have to give further consideration to its approach to situations in which the amount allotted to a plan exceeds the FLSA costs incurred by its contracted providers. DOH is also still considering options for covering FLSA-related costs on a prospective basis after April 1, 2016.

DOH clarified that plans do not have to collect attestation forms from home care agencies related to the use of the funds. These forms should be submitted to DOH. DOH will be releasing a survey through Mercer to home care agencies shortly to collect information about their FLSA expenses for purposes of distributing the full amount of the funds once federal approval is granted. When asked if there would be a retrospective reconciliation of the funds, DOH was non-committal.

QIVAPP

The IPRO audits of home care agency hours for purposes of the 2014-2015 QIVAPP distribution is in the final stages. The federal share of QIVAPP will be distributed after completion of DOH review of the audit report. In 2015-16, QIVAPP will be continued at the $70M level and distributed based on the criteria used in 2014-15. However, in 2016-17, the funds will be incorporated into plan rates and the criteria may be modified.

MLTC/PACE Rates

DOH staff outlined the status of various rate packages. The rate package timeline is available in the slide presentation here. Development of the 2016-17 rates will begin in the May-June timeframe and will include input from plans.

DOH described its plan for restoring $18M in PACE premiums recognized as a result of the resubmission of cost reports. These funds will be reinvested in PACE programs as follows:

A reduction in the Medicare Savings Adjustment;
an additional network incentive adjustment and;
an additional 2 percent investment in the quality pool.

DOH outlined changes in the methodology used to distribute Quality Incentive Pool funds. Some MLTC plans questioned the methodology. They pointed to the use of the UAS and new quality measures as the source of flawed results. DOH promised a more detailed conversation on this topic in an upcoming webinar. In addition, the managed care quality work group will meet in April. Plans asked for advance notice of the measures to be used in the upcoming year.

DOH recognized that enrollment of nursing home residents in managed care plans is accelerating. They have released a new nursing home resident enrollment survey for plans released, which will be used in developing the Phase V rates.

Plans asked for an update on the State takeover of the collection of Net Available Monthly Income (NAMI) amounts from nursing home residents. DOH indicated that it is still engaged in discussions with Centers for Medicare and Medicaid Services (CMS) on this issue and referenced the complexity of creating a new administrative infrastructure to manage collections. They mentioned the possibility of starting with a demonstration program in a few counties.

Value-Based Payment Surveys

The Department is surveying plans to learn more about the extent of their value-based payment (VBP) arrangements with providers. Survey responses should be based on 2014 data only. DOH has released FAQs to assist plans in completing the survey. The FAQs can be requested via this email address. The slides from this portion of the presentation are available here.

Managed Care Enrollment of Participants in NHTD and TBI Waivers

DOH highlighted the activities of the Nursing Home Transition and Diversion (NHTD)-Traumatic Brain Injury (TBI) Waiver Transition Work Group. The department will be posting a transition plan for these waiver programs in early April. It is encouraging plans to review the transition plan carefully and submit comments. The department acknowledged that there is some disagreement over the scope of the transition plan. DOH intends to include in the plan only what is required by the CMS, rather than incorporating every policy decision.

FIDA

DOH announced that "frequently asked questions" regarding the Fully Integrated Duals Advantage (FIDA) program's Integrated Appeal and Grievance Process have been posted on the DOH website. They are available here. In addition, DOH will be making available an advertising plan and updated marketing materials in the near future.

DSRIP Update

DOH provided an update on DSRIP and a description of the opt-out process for sharing of health information among DSRIP Performing Provider System (PPS) participants and plans. DOH is reviewing guidance on various information sharing scenarios. Plans that intend to share information with PPSs are responsible for ensuring that they have executed the appropriate agreements with the PPSs and that those agreements require PPSs to implement the appropriate controls over their information sharing with providers. Plans should consult with their attorneys to ensure that they are complying with all applicable privacy and security requirements.

DOH will be convening public comment meetings on the DSRIP program and MRT waiver. The downstate meeting will be in early May, and the upstate meeting will be in June. The slide presentation is available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.