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DOH Releases Draft Proposals on Future of MLTC and FIDA

The Department of Health (DOH) has released a draft white paper on the future of the Managed Long Term Care (MLTC) and Fully Integrated Duals Advantage (FIDA) programs.  The paper was developed to serve as the basis for discussion at the DOH Long Term Care Forum scheduled for Sept. 29th.   It proposes an enhanced "MLTC Plus" product that would:

  • Add primary and preventive care and behavioral health services to the benefit package;
  • Provide quality incentives for demonstrated achievement of certain primary care metrics;
  • Require certain protocols at transitions from the hospital to the community, in an effort to reduce avoidable re-hospitalizations; and
  • Apply the value-based payment reforms set forth in the NYS Roadmap, including measurement provider performance and payment arrangements that, at a minimum, involve shared savings.

It also includes a combination of measures to increase enrollment in FIDA, including changes in the enrollment process and penalties for low enrollment.  Specifically, it proposes to implement passive enrollment of dual eligibles who do not require long term care services and to freeze enrollment in MLTC plans operated by organizations that also operate FIDA plans, if the organization does not attain 25 percent enrollment in its fully-capitated products (i.e., FIDA, PACE and MAP) by December 2016.  In addition, the paper proposes:

  • Direct enrollment by plans, in addition to enrollment through the Department’s enrollment broker;
  • Intelligent assignment to match beneficiaries with plans based on primary care provider and home health relationships;
  • Implementing semi-annual passive enrollment in FIDA;
  • Offering Medicaid beneficiaries FIDA enrollment as their “first choice” upon enrollment in Medicare at age 65, if they are in need of long term care services;
  • Allowing beneficiaries to "opt-out" of the interdisciplinary team (IDT) care management process, while providing penalties and incentives based on participation;
  • Greater flexibility in FIDA plan marketing and a DOH-funded marketing campaign;
  • Requiring FIDA plans to implement "any willing primary care physician" policies;
  • Adding new behavioral health home and community-based services; and
  • Requiring plans to offer an “over the counter” drug card.

A more detailed summary of the paper's proposals is available here.  LeadingAge New York will be participating in tomorrow's Forum and analyzing these proposals.  We are seeking member input.  Please send your comments and concerns to Dan Heim, or Karen Lipson by Oct. 8th. 

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383, ext. 124.