DOH Discusses CFCO, Shares Draft Guidance
Last week, the Department of Health (DOH) held a meeting with Medicaid managed care organizations to outline the next steps in implementing the Community First Choice Option (CFCO) benefit and review several draft guidance documents. Starting on Jan. 1, 2019, both mainstream Medicaid managed care and Managed Long Term Care (MLTC) benefit packages will include the following services for CFCO eligible members: assistive technology; community transition services; moving assistance; home delivered/congregate meals; environmental and vehicle modification; and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (ADL) Skills Acquisition, Maintenance and Enhancement (SAME).
After a brief overview of CFCO services, the meeting focus turned to a detailed discussion of the draft guidance documents for authorizing assistive technology and environmental and vehicle modifications. The guidance documents are designed to be used by managed care plans as well as local social services districts (and HRA in New York City), and all three follow the same layout. Each document defines the specific benefit, lists the services included and any limitations, lays out requirements for the service providers, details the process for authorizing services, and lists the services not included under the specific benefit. Because the documents were partly modeled on existing Office for People with Developmental Disabilities (OPWDD) program and Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver dynamics, they warrant close examination to ensure they fully apply to managed care.
Participants identified and reiterated a number of previously identified concerns that included network adequacy, three bid requirements, considerations for selecting a bid, plan-provider contracts, reimbursement methodology, tracking of any benefit limits when members change plans, clarity for fair hearing purposes, and appropriate allocation of responsibilities between plans and providers. DOH requested comments on these three documents within two weeks of the Aug. 29th meeting.
The Department also shared draft guidelines for Person Centered Services Planning as well as a draft guide for consumers on Selecting, Managing and Dismissing Attendants with the request that stakeholders provide feedback on these within four weeks. All comments should be addressed to CFCO@health.ny.gov.
LeadingAge NY Contact: Darius Kirstein, firstname.lastname@example.org, 518-867-8841