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Future of Integrated Care Meeting Covers Networks, Member Rights, Marketing, and Quality

The Department of Health (DOH) convened the third stakeholder meeting on the future of integrated managed care on Oct. 16th. These meetings are intended to gather stakeholder input on the future design of managed care programs for individuals dually eligible for Medicaid and Medicare, after the expiration of the Fully Integrated Duals Advantage (FIDA) program in 2019. The Oct. 16th meeting agenda covered a broad array of issues, including network adequacy and access standards, quality measurement, member rights and protections, and marketing rules. Meeting slides are available here. To spur discussion, DOH circulated a draft contract between the state and a managed care plan in a hypothetical future program.

Reflecting on stakeholder input received to date, DOH noted that the majority of those who commented supported the inclusion of all dual-eligible beneficiaries in a new program, not just those who require long term care. In addition, stakeholder comments supported the inclusion of individuals eligible for Medicaid only who require specialized services. Stakeholders also sought coverage of all Medicaid and Medicare services, except certain high-cost drugs, end stage renal disease services, and hospice. DOH also reported that stakeholders requested coverage of additional services and supports, such as housing, over-the-counter drug discount cards, and services influencing social determinants of health. In addition, DOH noted that stakeholders wrote in support of continuing the interdisciplinary team (IDT) for care management and the 90-day continuity of care policy for new enrollees.

Discussing network and accessibility concerns, consumer advocates expressed concerns about the lack of availability of certain providers in certain regions. In particular, they pointed to lack of access to home care in certain areas and suggested that the network requirements for nursing homes under FIDA are too low. They urged consideration of the 5-Star ratings in determining network adequacy. Consumers also urged stronger enforcement of network requirements and accessibility standards. They also called for rigorous training of providers on best practices in serving individuals with disabilities. Managed care plan representatives noted that timeframes for appointments are unrealistic, especially for certain specialties. They also urged the expansion of telehealth modalities to reduce avoidable hospitalizations.

Stakeholders also weighed in on member rights, communication requirements, and quality measurement. Most supported an integrated appeals process, like the FIDA process, rather than splitting Medicare and Medicaid processes. Plan representatives called for interpretation and translation requirements that mirror the managed long term care (MLTC) requirements. They also noted the challenges associated with complexity, duplication, and volume of quality measures required by the FIDA program. Stakeholders were urged to submit comments by Oct. 26th and to respond to questions in a template. However, DOH noted that they would accept comments after the deadline.

The next and final meeting on integrated care will focus on enrollment. It will be held on Thurs., Nov. 16th from 11:30 a.m. to 2 p.m. at One Commerce Plaza (99 Washington Avenue), Room 1613, in Albany. Stakeholders may also participate via webinar/conference call. As space is limited, DOH asks that no more two people from an organization attend in person. Individuals planning to attend in person are asked to respond via email no later than close of business on Nov. 14th with the first and last names of attendees. To participate via webinar/call, register here.

Materials from other meetings are available here.

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