Waiver Transition Group Meets

Participants at last week's Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver Transition Workgroup meeting learned about the basics of managed care rate setting. Although the Department of Health (DOH) has not begun developing rates to reflect the incorporation of the waiver services into Medicaid managed care on Jan. 1, 2018, staff described the rate setting process and addressed questions and concerns from consumers and waiver services providers. Slides are available here. While DOH expects waiver service users to likely be high cost outliers in mainstream Medicaid managed care, they are less likely to be outliers in managed long term care.  However, adequate rate setting may be a challenge because while these individuals are likely to be high volume service users, their needs may not be reflected in assessment scores used to adjust rates for acuity.  DOH noted that waiver participants have historically underutilized Medicaid State Plan services, relying more heavily on waiver services.

There are currently 2,416 individuals in the NHTD waiver, with another 475 in the application process. The TBI waiver serves 3,188 individuals, with 463 in the application process. DOH recognizes that Community First Choice Option (CFCO) services overlap with waiver services and that CFCO users will likely far outnumber waiver participants. As a result, the DOH waiver transition team is waiting for other parts of the Department to issue CFCO guidance, which will then help guide the team's approach. CFCO services are scheduled to be implemented on April 1, 2017, although DOH acknowledges that the CFCO team still has much work to do.

DOH received 36 written comments on the Waiver Transition Plan, with commenters expressing common concerns regarding conflict free care management, the Uniform Assessment System, CFCO issues, rates, and general opposition to the transition.

In response to concerns raised about the implications of some of the definition changes stemming from the transition, specifically about service coordination, DOH staff assured participants that they are aware of the implications and that any change in definitions would not occur prior to the transition date.

Contacts: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 and Cheryl Udell, cudell@leadingageny.org, 518-867-8871