MLTC Expansion Bonus Program

The Department of Health (DOH) is moving forward with the release of funding for Program for All-Inclusive Care for the Elderly (PACE) and partial cap plans to encourage expansion into non-urban (vulnerable) counties in Upstate NY.   DOH recently announced the $15 million in Balancing Incentive Payment funding to promote expansion in 34 vulnerable upstate counties, 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 the Centers for Medicare and Medicaid Services (CMS) requires program funds to be dispersed by then.  DOH acknowledges that the timeframe and deadlines are tight and rigid for the bonus payments.

For your convenience, the following DOH MEPB resources are posted on our website:

• The Letter of Intent (LOI);
• A detailed program explanation; and
• A frequently asked questions guide.

The timeframes for applying and the distribution of funds are very tight.  Please note the following timeline for qualifying for funds:

• Submit Letter of Intent for the BIP Expansion/Bonus plan by Nov. 7, 2014;
• PACE applications due Dec. 1,, 2014
• New MLTC Partial Plans due Feb. 2, 2014;
• Service Area Expansions due March 2, 2015; and
• Have an enrollment level of 25 members by Sept. 1, 2015.

Again, LOIs are due Nov, 7, 2014. Instructions for how to complete and submit an LOI are included in the form linked above. Questions should be directed to Karen Ambros, BIP director, by email at BIP@health.ny.gov or call (518) 473-6596.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827