Summary of Jan. 9 DOH Managed Care Policy and Planning Meeting
The Department of Health (DOH) convened a managed care policy and planning meeting for health plans on January 9. The meeting included presentations on the following topics:
- Amended MRT Waiver Implications
- Finance and Rate Development
- MLTC/FIDA Update
- FIDA Quality Performance Metrics
- Behavioral Health/HARP
- Early Intervention
- NYS Health Innovation Plan (NYSHIP)
- Access and Availability Survey
The handout materials included:
- January 2014 – March 2014 Medicaid Managed Care and Family Health Plus Premium Rates
- FIDA Quality Performance Metrics
- Affordable Care Act and Medicaid Expansion Rate Adjustment for Medicaid Managed Care and Family Health Plus
- MLTC/FIDA Rates Update
Managed long term care (MLTC) and Fully Integrated Duals Advantage (FIDA) program items of interest to LeadingAge New York members included:
MLTC/FIDA Rates
DOH indicated that there will be no nursing home rate cell built into MLTC premiums; there will, however, be a nursing home rate cell for mainstream Medicaid managed care plans. DOH is open to other mechanisms for mitigating the risk associated with nursing home utilization in MLTC plans, including risk corridors, acuity adjustments and a high-need pool.
On a related rate issue, DOH indicated that they will be, for the foreseeable future, promulgating nursing home fee-for-service rates and that these rates will be used as the floor for negotiating contract rates for the first three years of the nursing home population transition (extended one-year beyond the originally proposed two-year period).
FIDA Update
DOH reported that discussions with CMS concerning the Interdisciplinary Teams (IDTs) are ongoing and indicated that a revision would be forthcoming.
The discussion also included a presentation on FIDA Quality Performance Metrics. FIDA will need to comply with the list of Core Quality Measures as detailed in the MOU with CMS. DOH is seeking plan input for finalizing the measures, including possible measures that New York would add to the core group. LeadingAge NY will be seeking member input on recommendations to the quality measures.
Contracting with LHCSAs for Skilled Services
The Department discussed the permissibility of contracting with LHCSAs for skilled home care. Based on federal regulations and CMS policy guidance, the Department believes that plans cannot contract with LHCSAs for nursing, OT, PT, or skilled home health aide services. It is not clear whether CHHAs may subcontract with LHCSAs for those services. DOH counsel’s office is continuing to analyze these questions, and a Dear Administrator letter is expected in the near future.
Upstate Transition Plan
DOH announced that the Upstate Managed Care Transition Plan will be posted on the MRT website.
Please provide LeadingAge New York with any comments for DOH consideration.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827