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DOH Issues Managed Care Plan Notices

The Department of Health (DOH) issued two notices to managed care plans, on Sept. 12, 2023, related to their Medicaid payments. First, the Department has paused the implementation of the State Fiscal Year (SFY) 2022-23 withhold returns and penalties related to partially capitated plans' enrollment caps. This action appears to be in response to impending acquisitions of partially capitated plans. The Department's notice indicates that it "will be considering the upcoming transactional announcements" from partially capitated plans and will issue more information.

The enrollment cap notice also includes each plan's SFY 2023-24 enrollment cap targets. If a partially capitated plan will be acquiring another plan before the end of SFY 2023-24, the plan’s targets will be readjusted to address the acquired plan’s targets.

In addition, the Department issued a notice reminding plans of the increase in the managed care medical loss ratio (MLR) from 86 percent to 89 percent that was enacted in the SFY 2023-24 budget to take effect as of April 1, 2024. The increase applies to the mainstream and Managed Long Term Care (MLTC) partially capitated products. The MLR percentage for HIV Special Needs Plans (SNPs), Medicaid Advantage Plus (MAP) plans, Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) plans, and Programs of All-Inclusive Care for the Elderly (PACE) will remain at 86 percent, and Health and Recovery Plans (HARPs) will remain at 89 percent. The MLR Reporting Period will align with the rating period for each type of plan, in accordance with 42 CFR §438.8(b)). For partially capitated and mainstream plans, the rating period is the SFY (April 1st – March 31st).

For MAP plans and certain other fully capitated plans, the Department further announced an increase in rates for certain services licensed by the Office of Addiction Services and Supports (OASAS). The rate increases are effective retroactive to Jan. 1, 2023 and March 1, 2023 as applicable.

The Department also circulated to partially capitated plans the new Jan. 1, 2022 – Dec. 31, 2026 Model Contract for signature.

Contact: Karen Lipson, klipson@leadingageny.org