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January Managed Care Policy and Planning Meeting Highlights

The Managed Long Term Care (MLTC) portion of the January Managed Care Policy and Planning meeting held last week featured updates from the Division of Long Term Care (DLTC) and the Delivery System Reform Incentive Payment (DSRIP) Program Deputy Director as well as a brief discussion on Value Based Payment (VBP). Highlights of the meeting most relevant to MLTC members are outlined below. Section headings link to any associated handouts, and the agenda is posted here.

DLTC Status Update

With minimum wage funding flowing, the Department of Health (DOH) is seeking to schedule a workgroup meeting on minimum wage oversight and education. The meeting will be for all plans (i.e., MLTC and mainstream) and will include representatives from the Division of the Budget, Department of Labor, Office of the Medicaid Inspector General, and DOH. A Nursing Home Transition and Diversion/Traumatic Brain Injury (NHTD/TBI) Waiver Transition Workgroup meeting is scheduled for 10 a.m. on Jan. 26th. Information is available by emailing waivertransition@health.ny.gov.

DOH reminded plans that MLTC Policy 16.08, posted in December and available here, clarifies that the Conflict Free Evaluation and Enrollment Center (CFEEC) evaluations for Community Based Long Term Care (CBLTC) eligibility are now valid for 75 days rather than the previous 60 days. After 75 days, a new evaluation will be required if the consumer does not select an MLTC plan but continues to seek CBLTC.

The Centers for Medicare and Medicaid Services (CMS) is accepting comments until Feb. 10th on potential adaptations of the PACE model to serve expanded populations. More information on the CMS solicitation is posted here, and the Request for Information (RFI) document can be accessed here. Andrew Segal, Director of DLTC, said that he is in favor of PACE expansion and that the state is very interested in this initiative, and he encouraged organizations with experience with the PACE model to submit comments.

Statewide enrollment in all MLTC plans stood at 187,673 in December, up 13,538 (7.8 percent) from August. About 5,000 are enrolled in the Fully Integrated Duals Advantage (FIDA) program, with single capitation plans representing 90.6 percent of enrollment. MLTC is growing faster than expected, and the state is performing an analysis to better understand the growth. Of the 6,627 CFEEC evaluations requested in December, 9 out of 10 were for individuals living in the community.

FIDA plans should have received a red-line version of the revised Three-Way Contract and are asked to provide feedback during the Jan. 20th FIDA call. The state will discuss potential policy changes to the FIDA program with plans in the next few weeks then engage the public in a broader discussion of integrated care in the state. Voluntary enrollment into FIDA in Suffolk and Westchester counties will begin in February with one plan, with other plans phased-in contingent on final network review. No passive enrollment is scheduled for these counties at this time.

DOH convened a Community First Choice Option (CFCO) workgroup meeting on Jan. 5th that divided planning activities into four subgroups: Provider Management, Benefit Management, Clinical Management, and PACE Issues. The groups will be geographically balanced and include both MLTC and mainstream plans. Plans may still nominate staff to the workgroups by emailing CFCO@health.ny.gov.

While there was no MLTC rate update, DOH did provide the following MLTC rate-related dates:

  • Risk Adjustment Workgroup: Jan. 23th
  • PACE Rate Webinar: Jan. 26th
  • MAP Rate Webinar: Jan 27th
  • FIDA Rate Webinar: Early February
  • MLTC Rate Setting Program Alignment Webinar: Early February

DSRIP Update

Medicaid Director Jason Helgerson reassured participants that any potential repeal of the Affordable Care Act (ACA) should not have a direct impact on the state’s DSRIP program. DSRIP is not an ACA program and has been extended until 2021 by CMS. The state believes that all mechanisms and tools are in place for it to continue, although fundamental changes in Medicaid financing could have an effect.

DSRIP Deputy Director Diane Kiernan outlined project timelines (see slides) and stressed that a lot of funding is tied to Measurement Year 3 as the payments shift from rewarding reporting to rewarding project outcomes. PPSs earned 99.40% ($1.2 billion) of all available funds for DSRIP Year 1. To questions on what would happen with DSRIP funding if PPSs failed to meet established milestones, DOH explained that such funds would go into high performance pools and be redistributed to other PPS based on specified achievement levels.

PPSs are currently involved with midpoint assessment activities. The Independent Assessor (IA) reviewed projects, and PPSs have specified timeframes to address any recommendations. The IA found no major problems, and the recommendations were focused on organizational and project improvements the PPSs should make to improve the likelihood for the successful implementation of the DSRIP project plan. Public comments from the second comment period are due to the IA by Jan. 23rd, with a public hearing scheduled for Jan. 31st and each PPS presenting how they are doing to the oversight panel in early February.

There have been some changes and timeline flexibility regarding VBP milestones and progress reporting in DSRIP. Readiness levels vary, with some PPSs on track and working with hired VBP consultants and others moving more slowly.

The Community Based Organization (CBO) Planning Grant (RFA # DOH01-CBOPGR-2017) solicitation in the combined region covering both the Hudson Valley and Long Island areas has been reissued. Applications are due into Grants Gateway by Feb. 10, 2017 at 4 p.m. Questions can be sent to OHIPContracts@health.ny.gov.

Value Based Payment

Jason Helgerson reported that he expects the most recently updated version of the state’s VBP roadmap to be approved soon by CMS. The state is distilling the VBP boot camp information into fact sheets that will be available shortly. The master VBP workgroup meeting to discuss the various Clinical Advisory Group (CAG) reports originally scheduled for Jan. 17th has been rescheduled for three weeks into the future.

The state wants to conclude policymaking on VBP and hopes to finalize VBP pilots for mainstream managed care plans by April 1st. Plan-specific rate adjustments are anticipated in 2019-20 and will be phased in over time.

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