November Medicaid Managed Care Plan Meeting Highlights
Highlights of the November Medicaid Managed Care Policy and Planning meeting of interest to Managed Long Term Care (MLTC) plans are outlined below.
Enrollment. Overall Medicaid managed care enrollment grew by about 2,800 to reach 5.9 million in October. Partially Capitated Medicaid MLTC enrollment dipped by 1,150 due to the Oct. 1st batch disenrollment of long-stay nursing home residents. Programs of All-Inclusive Care for the Elderly (PACE programs) added about 270, reaching 7,800 participants. Medicaid Advantage Plus (MAP) increased by 75 and stood at 34,764.
Due Dates. Cost reports for the third quarter of 2022 were due Nov. 15th for all plan types. The Medicaid Medical Loss Ratio (MLR) Report for State Fiscal Year (SFY) 2021-22 (i.e., April 2021 through March 2022) will be posted in January 2023, with plans having 60 days from the posting date to complete the report. The Department of Health (DOH) plans to do more outreach in the next few weeks regarding encounter reporting compliance reviews.
Social Day Oversight. While DOH expressed appreciation for MLTC active efforts to partner with DOH in the Social Adult Day Care (SADC) site evaluation process, it did indicate that it would impose regulatory consequences for plans that do not respond or refuse to participate.
The Department has made some minor updates to the evaluation tool that MLTCs should be utilizing when the plan conducts an evaluation survey or when completing an initial evaluation prior to contracting. The related Frequently Asked Questions (FAQs) have been separated into two documents: one set focused on the evaluation tool, the other on the Home and Community-Based Services (HCBS) Settings Rule.
NYIA Update. DOH indicates that it observed overall improvement on appointment availability, with the vast majority of requestors getting appointments within 14 days. September initial assessment requests totaled 10,239, lower than during summer months. Most of those requesting assessment were enrolled in Medicaid fee-for-service (FFS) (58 percent), and 34 percent were Mainstream enrollees. The New York Independent Assessor (NYIA) fielded 60,195 calls, with an abandonment rate lower than 2 percent and average answer time less than a minute. There were 12,766 outcome notices sent out and 76 clinical variance requests.
On Dec. 1st, DOH will transition immediate need/expedited review requests currently handled through local districts, both for those with and without Medicaid eligibility. A similar process will be in place for mainstream plans. Any requests underway at the transition will be handled under the current process. All reassessments will continue to be done by the plans until further notice. There is no change for MLTC plans.
Other Issues. There continue to be concerns on the part of home care providers on completing the wage parity LS300 form. DOH indicated that it is working on a written response to that issue.
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841