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CFCO Benefit Carve-in Now Scheduled for April 2017

The Managed Long Term Care (MLTC) portion of the October Medicaid Managed Care Policy and Planning meeting featured program updates as well as a DSRIP presentation. The most significant news was the delay of the Community First Choice Option (CFCO) implementation from Jan. 1st to April 1, 2017. There was no MLTC rate presentation this month. Highlights of the meeting are provided below. Section titles link to associated handouts.

MLTC-FIDA-CFCO Update

DOH reported statewide MLTC enrollment of 179,172 with partial capitated plan enrollment up by almost 5,000 since August. With the recent addition of new staff, the delays that some plans had experienced with the Conflict-Free Evaluation and Enrollment Center (CFEEC) process seem to have been resolved. CFEEC call volume averages 921 per day, with 80 percent of evaluations being conducted within seven business days. The approval rate continues to be 97 percent.  

The state is continuing its Fully Integrated Duals Advantage (FIDA) outreach and advertising initiative and is sending letters to 6,800 providers encouraging them to join FIDA networks. Beginning in late October, 85,000 letters targeting individuals enrolled in MLTC and those who have opted out of FIDA will urge recipients to take another look at FIDA. Advertising materials and the slides DOH presented during a Sept. 16th FIDA update webinar are available here. DOH reports that 15 percent of new FIDA enrollees became aware of FIDA through the media campaign, 12 percent through a healthcare provider, 6 percent through family or friends, and 66 percent through other referrals.         

Since the last Policy and Planning meeting, DOH has posted MLTC policy 16.04 describing additional supports available through the Money Follows the Person (MFP) Demonstration as well as meeting materials from the September Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) Waiver Transition meeting. These include common elements of public comments DOH received on the draft transition plan as well as a 1915(c) Waiver Transition Timeline for NHTD and TBI Waivers, which details scheduled steps leading to implementation on April 1, 2018. The next public workgroup meeting will be held on Wed., Nov. 16th at 10 a.m.  Information about the meeting can be obtained by emailing waivertransition@health.ny.gov.

Although the implementation date of CFCO has been moved to April 1, 2017, DOH is seeking to complete most of the logistical decisions and provide plan guidance regarding CFCO by early December to allow plans and the state to develop networks and systems. Meeting participants again made the suggestion that DOH develop guidance and outreach materials with plan input and participation. The state agreed with that approach and intends to include both plans and CFCO services providers in the discussion, although the state's intention is to issue initial guidance within two weeks. Preparation activities that DOH has completed include development of a CFCO services member handbook supplement, finalization of a template letter for plans to distribute to members, and the drafting of a policy paper providing plans with guidance on the carve-in of the new services. The October issue of the DOH Medicaid Update will provide CFCO information as well.

DOH has posted the contact information of organizations that offer CFCO services and who are current NHTD/TBI waiver services providers here, and specified the following relative to CFCO preparations:

  • Contracting – Plans are encouraged to amend contracts with existing network providers that may also appear on the provider list;
  • Assessment – Current plan enrollees do not need a Level of Care determination to access CFCO services unless one is requested by the enrollee; 
  • Agency with Choice Model – The voluntary training program will be available to enrollees and their workers;
  • Person-Centered Service Planning (PCSP) process – Risk assessment, an integral part of the PCSP process, is the responsibility of the Care Manager. The Care Manager must ensure that a risk management plan is completed and updated, along with the PCSP.

DSRIP Update

DSRIP Director Peggy Chan reviewed the DSRIP implementation timeline and provided updates on key issues. The state is in the second quarter of DSRIP Year 2, and the focus is beginning to shift from infrastructure development and system design to continued system and clinical improvement. Payment is shifting from pay for reporting to pay for performance, with $902 million in DSRIP dollars at stake based on performance measures being collected between July 2016 and June 2017.

The state held the second annual DSRIP PPS Learning Symposium in September. Presentation materials from the sessions are available here. Value Based Payment (VBP) Boot Camps are coming to a close, but complete Albany session recordings along with other resources are available on the DSRIP VBP Library web page. In-person individual boot camp session attendance varied from 209 in the Bronx to 31 in the North Country. All but four mainstream Medicaid managed care plans now have access to their DSRIP dashboards.   

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841