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FIDA Extended for Two Years

Along with program and rate setting updates, the Managed Long Term Care (MLTC) portion of November's Managed Care Policy and Planning Meeting featured a presentation on new federal requirements on outreach materials and communications, the role of managed care in ending the HIV epidemic in NYS, and the Advanced Primary Care (APC) program. The Department of Health (DOH) also noted that the state has decided to extend the Fully Integrated Duals Advantage (FIDA) demonstration for two years through December 2019 and will be rolling it out in Westchester and Suffolk counties in 2017. The letter announcing the extension is available here

Brief highlights of the presentations most relevant to MLTC are provided below. Section headings link to the associated handouts.

MLTC Rate Setting

The DOH rate presentation focused on minimum wage and provided a review of the guidance document that was recently finalized and shared. Per DOH, rates for New York City MLTC plans will reflect an increase of $1.33 per hour (risk adjusted), which plans will need to pay out entirely or return to DOH. While plans may renegotiate rates, minimum wage funding cannot be used to subsequently increase rates after a reduction to addresss minimum wage. The state will implement additional cost reports that will be used to ensure that money associated with minimum wage is used appropriately and to facilitate a reconciliation of minimum wage payments up or down as needed.

Questions and requests for clarification from plans on the specifics of the guidance indicated that a number of details still require resolution. Discussions continue to hammer out the final details.

MLTC-FIDA-CFCO

FIDA has been extended for two years with the advertising campaign in full swing. DOH reports that the campaign activities are on schedule, with letters sent to over 6,000 providers encouraging them to take a second look at FIDA. Letters have also started to go out to newly eligible individuals and those who have opted out previously to educate them about the program. The rollout into Suffolk and Westchester counties is anticipated in 2017. The state intends to launch a stakeholder process in 2017 to evaluate whether and how to consolidate or maintain existing integrated products.

New Federal Regulatory Requirements

Section 1557 of the Affordable Care Act requires that significant plan publications and communications include a seven-component non-discrimination statement as well as taglines in the 15 most common non-English languages in the state. It applies to all MLTC plans, including Single-Capitation plans, PACE, MAP, and FIDA. Plan determination notices are deemed to be significant communications. The taglines and full non-discrimination statement must also be posted in physical locations where a plan interacts with the public as well as on the plan's website. DOH has created and will share sample inserts that meet federal requirements, and urges plans to use these until their materials are updated.

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