New Dear Administrator Letter for LHCSAs on MLTC Contract Cap
The Department of Health (DOH) issued a Dear Administrator Letter (DAL) to all Licensed Home Care Services Agencies (LHCSAs) last week relating to the 2018-19 budget language that requires Managed Long Term Care (MLTC) plans to cap the number of contracts they have with LHCSAs.
The DAL provides a link to recent DOH guidance for MLTC plans on the cap. This document addresses the following issue areas and provides examples to illustrate each provision:
- Provider to enrollee ratios;
- LHCSAs with multiple sites within an upstate or ROS region constitute one contract;
- Treatment of Independent Practice Associations (IPAs);
- Factors that MLTC plans need to consider in establishing limits;
- Enrollee notification;
- Network adequacy;
- Exceptions to the limits and how to request one; and
- Plan Compliance.
You can view the MLTC guidance and a summary of its provisions here and here.
The LHCSA DAL also reminds all agencies of the existing laws and regulations that may come into play as LHCSA contracts are terminated by MLTCs, enrollees move to other plans or providers, or agencies close. DOH reminds agencies of state and federal anti-kickback provisions that prohibit offering, paying, soliciting, or receiving any payment in return for referring a Medicaid recipient to a LHCSA or other Medicaid service provider.
Other relevant state regulations and guidance to be mindful of:
- 765-2.3 Discontinuation, revocation, suspension limitation or annulment of a license;
- 766.1 Patient rights;
- 766.2 Patient services policies and procedures; and
- 766.3 Plan of care.
LHCSAs considering closure must comply with DOH’s Closure Plan Guidelines for Providers and must work with their DOH regional office to facilitate that process.
Please look over this document, its links, and referenced regulations carefully. Please contact Meg Everett if you have any questions or concerns regarding this issue.
Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871