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Stakeholders Discuss Future of MLTC and FIDA at DOH Long Term Care Forum

On Sept. 29th, the State Department of Health (DOH) convened a forum on the future of the Managed Long Term Care (MLTC) and the Fully-Integrated Duals Advantage (FIDA) programs.  Representatives from LeadingAge New York and the Adult Day Health Care Council participated in the forum, along with over 100 other stakeholders and leaders from DOH and the Centers for Medicare and Medicaid Services (CMS).  The discussion focused on a DOH draft white paper that recommended the creation of an MLTC Plus product and the implementation of various steps to increase enrollment in FIDA plans.  A summary of the white paper is available here, and the slides presented at the forum are available here.    

MLTC Plus Product

Mark Kissinger and Jason Helgerson led the discussion related to the proposed MLTC Plus product.  A key component of the proposal is to select a limited number of plans to offer the MLTC Plus product and to work closely with Delivery System Reform Incentive Payment (DSRIP) Performing Provider Systems (PPSs) on specified projects aimed at reducing hospital admissions. In addition, the MLTC Plus plans would be expected to actively engage in value-based payment arrangements. 

LeadingAge NY expressed support for the goals of the MLTC Plus product, including strengthening the connection between primary care practitioners and MLTC plans and improving care transitions.  However, we cautioned that the growing array of managed care products and care models is confusing to providers and consumers alike, and we asked DOH to explore stabilizing and refining existing models, rather than creating a new product for a few selected plans.  We also urged DOH to be realistic in its expectations for value-based payment in the long term care sector.  We noted that the overwhelming majority of savings generated will accrue to Medicare and that there is little experience with value-based payment in long term care.  In addition, we highlighted the need for public investment in long-term/post-acute care health information technology, health information exchange, and data and analytics infrastructure, in order to support value-based payment. 

FIDA

The FIDA segment of the discussion focused on various interventions to increase enrollment in FIDA, including relaxation of certain marketing rules.  Notably, a CMS representative clarified that MLTC care managers may provide factual information regarding FIDA without being credentialed as marketing agents.  Many participants raised the Interdisciplinary Team (IDT) as a barrier to physician and beneficiary participation in FIDA and explored solutions ranging from elimination of the IDT to expanding flexibility in its operation. 

LeadingAge NY representatives  expressed support for the Department’s proposals to relieve some of the marketing restrictions and requirements.  We raised concerns about the DOH proposal to penalize organizations in which less than 25 percent of their total managed care members are enrolled in fully-integrated plans (e.g., FIDA, PACE or Medicaid Advantage Plus plans).  We pointed out that the proposal to freeze enrollment in the MLTC plans sponsored by these organizations would be self-defeating, as it would limit consumer choice, cut off a potential source of FIDA enrollment, and drive organizations out of the FIDA program. 

LeadingAge NY will be submitting written comments on the proposals set forth in the draft white paper.  DOH has asked for comments by Oct. 9th.  LeadingAge NY members are encouraged to submit their comments on the paper and any new proposals for strengthening the MLTC and FIDA programs to Karen Lipson by October 8th.

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