Managed Care Policy and Planning Meeting
The Department of Health (DOH) hosted their monthly Managed Care Policy and Planning Meeting on Oct. 16 in Albany. For member convenience, we have posted all of the reference materials from the meeting on our website as follows:
October 2014 Schedule of Meetings for 2015
October 2014 DISCO - Putting People First
October 2014 MLTC and FIDA Update
October 2014 Mainstream Rate Package
October 2014 DRAFT BIP Bonus Payments
October 2014 DRAFT MLTC and PACE Upstate Expansion
October 2014 Adult Behavioral Health Update
October 2014 Health Home Update
October 2014 Ending the AIDS Epidemic in New York
October 2014 Genetic Prenatal Testing
Please note that included in this list of materials is the 12-month meeting schedule for 2015.
General Information
Hospice
The Department of Health (DOH) acknowledged that questions remain as to the coordination of hospice services and managed care. To respond to ongoing concerns DOH will be hosting a webinar that will cover issues of paying the fee-for-service rate during the current transition period and how hospice is covered in the nursing home under managed care.
NYS Comptroller
The State Comptroller’s Office is seeking more information on the transition to managed care; in particular they are asking detailed questions about how Medicaid managed care rates are established. DOH and Mercer are making the case that rates are actuarially sound.
Three-Way Contracts
The Centers for Medicare and Medicaid Services (CMS) is continuing to ask questions regarding the model three-way contract, with a focus on program integrity. DOH is reviewing the program integrity piece and will respond to CMS accordingly.
Auto-Assignment Fix
DOH reports that they are close to concluding the revised process for auto-assignment into the NY Health Exchange. The process is slated to resume in 2015 with a gradual roll-out in order to manage the process more effectively. Given the large number of individuals who are selecting their own plans, DOH anticipates that the number of auto-assignments will remain relatively low. They have tested the formula for auto-assignment and believe that the problems have been resolved. Nonetheless, the resumption of auto-assignment will be implemented cautiously. There is a new Health Exchange ad campaign being planned and the expectation is that this will generate upwards of an additional 300,000 individuals in the Exchange.
Computer Sciences Corporation
DOH had experienced a contracting issue with Computer Sciences Corporation (CSC) as increased activity with managed care implementation had early on exceeded the estimated hours built into the contract, resulting in the State owing CSC $100 million for extra service hours. These contract issues have been resolved and CSC is now adding additional staff and other resources necessary to deal with the added work flow related to managed care implementation.
ID Cards
Plans have expressed concern that enrollees are not receiving their health insurance cards on a timely basis. DOH stated that enrollees can use their welcome letters while waiting for their cards. The delay is due in part to the fact that they have 30 days in which to select a primary care provider.
Family Health Plus
Family Health Plus is still slated to end as of Dec. 31, 2014 as this population transitions to the NY Health Exchange. There is still a large number of individuals who need to transition. In many cases, enrollees are simply transitioning to a plan that is sponsored by the current Family Health Plus plan.
AIDS/HIV SNPs
The plans raised concern that individuals with AIDS/HIV that are new to Medicaid do not have the option of enrolling in the appropriate special needs plan. DOH advised that these enrollments are handled through the local districts.
OMIG
The plans raised concern with Office of Medicaid Inspector General (OMIG) audits relative to enrollees whose Medicaid status changes mid-stream. The plans believe that it is not fair to penalize the plans when due to factors outside of the plan’s control an enrollee’s Medicaid status is denied retroactively, while the plan has continued to provide services. DOH will meet with plans and OMIG to further review the situation.
Aligning Managed Care and DSRIP
DOH is also seeking to work with plans on an initiative to develop recommendations on how to incorporate managed care plans into Delivery System Reform Incentive Payment (DSRIP)/Performing Provider Systems (PPS) arrangements. A report is due to CMS by April 2015. The focus is to align the goals of managed care with the goals of DSRIP, including how managed care plans can enter into contracts with PPSs. Does the PPS eventually become an ACO?
QI/VAPP
Quality Incentive/Vital Access Provider Pool (QI/VAPP) applications have been received and are under review. DOH expects to begin making awards in November.
DOH is continuing negotiations with CMS over the terms and conditions for implementing the Developmental Disabilities Individual Support and Care Coordination Organizations (DISCOs), that seek to cover services for the developmentally disabled under managed care. CMS is seeking to ensure that the DISCOs align with the goals of the Balancing Incentive Program (BIP). Following is the current timeline of key milestones:
8/22/14 Plan Qualification Document for DISCO/COA approval released (Includes Attachment 10 for DISCO start-up funds);
10/20/14 - Proxy DISCO rates posted for grant application fiscals;
11/3/14 - IMPORTANT DEADLINE – to apply for start-up grants;
11/20/14 – Additional Finance section of start-up grant application due;
12/1/14 - Funding approval/ contracts begin - tentative awards;
12/2014 - OPWDD/FIDA rates final & released (Webinar w/actuaries);
7/1/15 - OPWDD/FIDA enrollment begins; and
10/1/15 - DISCO enrollment begins.
The current rolling application process for plans wishing to become DISCOs will continue throughout this timeline, however, there is a deadline of Nov. 3 for those plans seeking start-up grants. As detailed in the linked slide presentation, the approval process for DISCO plans will mirror the certificate of authority (COA) mechanism in place for managed long term care plans. DOH believes that using the COA process will expedite the overall approval process. The COA application document is available by clicking here.
DOH emphasized that the grant dollars are to go towards start-up costs and cannot be used for “bricks and mortar”. Applicants should note that although the standard grant amount is listed as $1.5 million, awards in excess of this amount are possible if justified in the grant application.
The three-way contract is in the final approval stages with both NYS and CMS, with some final contingency issues that need input from plans. State execution process of the three-way contracts has been completed, and the executed contracts have gone to CMS. Contracts will be fully executed in October but contingent upon the final readiness reports that will be issued in November. Talks with CMS include a process to streamline training requirements.
The most recent encounter data has been release to plans and DOH has notified plans that future encounter data will continue to be reported in the MEDS III format.
Regarding marketing, the remaining Participating Handbook Chapters (3, 4 and 9) and a Part D Model Transition Letter were issued on Oct. 3. Completed materials need to be submitted to HPMS by close of business on Oct. 21. DOH also released the template ID card, which is due back on Oct. 22. A FIDA FAQ on marketing has been posted and is available by clicking here.
The slide presentation contains the passive enrollment schedule, beginning no earlier than April 1, 2015 in Region 1 (NYC and Nassau). DOH clarified that individuals residing in nursing homes prior to Jan., 2015 will not be passively enrolled, and individuals new to custodial nursing home care as of Jan. 1, 2015 will be passively enrolled into FIDA on or after August 1, 2015. DOH acknowledged that the initial number of nursing home enrollees will be smaller than originally estimated and they are taking a “wait and see” approach in terms of expanding the enrollment of this population.
Weekly FIDA implementation calls with plans will start the week of Oct. 17.
Conflict Free Evaluation and Enrollment Center (CFEEC)
The phase in of CFEEC became effective as of Oct. 1 for individuals seeking community-based long term care (CBLTC) services for more than 120 days for region 1 (Manhattan and the Bronx). The DOH resource page on CFEEC is available by clicking here. Region 2 (Kings, Queens, Nassau and Richmond) are slated for November.
Medicaid Advantage Program (MAP) Contracts
DOH acknowledged that the revised contract approvals for MAP have not been finalized with CMS; therefore DOH will be granting extensions on current contracts.
Please see the referenced slides for the latest status and timelines for mainstream rates, including Aliessa.
DOH announced that they have final CMS approval on Jan. 1 rates, which are now in the process of being uploaded to the system and official notice to the plans should be released shortly. Plans are reminded that mandatory rates began as of July 2012 and the transition to fully blended rates is set to be finalized as of April 2015.
Balancing Incentive Program (BIP)
DOH announced $15 million in BIP funding to promote expansion of MLTC in 34 vulnerable upstate counties. The funding is available to partial cap and PACE programs, with an emphasis on PACE as a comprehensive benefit package.
Payments to plans will be linked to expansion or new applications process so that “seed” money can flow initially upon acceptance of the Letter Of Intent (LOI) with subsequent payments for reaching two other key milestones: application approval, and actual enrollment in counties. Payment size will be tied to the number of counties a plan expands into. The BIP funding ends on Sept. 30, 2015 and CMS requires program funds to be dispersed by then. DOH acknowledges that the timeframe and deadlines are tight and rigid for the bonus payments. A program design paper and LOI are due out shortly.
Draft documents on the BIP funding and the upstate expansion are linked above.
Nursing Home Transition Billing Workgroup
DOH has established the Nursing Home Transition Billing Workgroup to prevent and address any claim or billing issues that may arise between plans and nursing homes, and to assist plans and NH’s in establishing mechanisms to work together on claim processing and billing issues. LeadingAge NY is a participant in the work group and is mirroring the efforts of the State group with our own internal work group.
The initial meeting of the group resulted in a decision to revise and resend the plan readiness survey to include more specifics on:
Number of rejected and accepted claims;
Of those accepted, number of paid and denied claims;
A listing of the most common reject and denial reasons; and
Identify which Plans may already have outreach/education activities in place.
The nursing home associations will review the most common denial reasons and the group will develop reporting statistics to evaluate billing issues.
Adult Behavioral Health Update
DOH distributed plan deliverables on Sept. 19 that included detailed plan requirements and timelines, with a subsequent Oct. 6 email with revised data. OMH and OASAS are in the process of scheduling readiness reviews with plans. This review will include an overview and walkthrough with the plans. The slide presentation contains a detailed plan deliverables timeline.
The DOH presentation on health homes focused on the Medicaid Analytic Performance Portal (MAPP). The MAPP is a performance management system that will provide tools to the Health Home network to support providing care management for the Health Home population. Health Home tracking system functions will be incorporated into MAPP and access expanded to care management administrators in Feb. 2015. DOH anticipates that future phases will include performance management tools and a care management record. MAPP will also support DSRIP program performance and population management technology needs.
DOH also noted that 2012 Health and Recovery Plan (HARP) members were included in health home assignment files in May 2014. The goal is for managed care plans and health homes to prioritize the assignment of HARP members. DOH acknowledges that the process for enrolling health home members into managed care plans still needs clarification.
MRT Affordable Housing Awards
Slide 15 of the presentation notes that ten organizations will be awarded a maximum of $400,000 for a tentative contract period beginning Oct. 1, 2014. Thirteen Health Homes will be involved in the pilot and will serve at least 350 members across 20 counties.
Conclusion
The meeting concluded with two important presentations on Ending the AIDS Epidemic in New York and Genetic Prenatal Testing. The AIDS session emphasized the Governor’s goal of eliminating the AIDS epidemic in New York. If accomplished, New York would be the first government agency to accomplish this. The report asserts that recent advances in the treatment and prevention of AIDS and the current epidemiological trends all point to the success of this important initiative.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8383, ext. 145