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Stakeholders Urge Enhancement of Medicaid Advantage Plus Program at Future of Integrated Care Meeting

The Department of Health (DOH) convened its fifth and final "Future of Integrated Care" meeting on Dec. 8th to receive stakeholder input into the configuration of a Medicare-Medicaid managed care program that would succeed the Fully Integrated Duals Advantage (FIDA) program. The meeting included presentations by staff from DOH on Medicare Advantage and integrated manage care plan enrollment in New York State and by the Integrated Care Resource Center (ICRC) on other states' approaches to integrated managed care. In addition, the ICRC provided a white paper on integration options using Medicare Dual Eligible Special Needs Plans.

Stakeholders weighed in on the geographic scope of a new program, seeking additional opportunities for integrated managed care upstate, where plan and beneficiary participation is lower than downstate. Other stakeholders expressed concerns that a focus on upstate would delay expansion in the New York City metropolitan area, where there has been more extensive development of integrated plans. Some stakeholders cautioned against network adequacy requirements that would impede expansion in areas where provider availability is limited or where physicians are reluctant to join networks. Others maintained that there are higher rates of enrollment when network adequacy requirements are robust.

Participants also discussed the possible administrative frameworks for the new program – whether to use the Centers for Medicare and Medicaid Services (CMS) Financial Alignment Initiative's Medicare-Medicaid Plan (MMP) platform that was adopted for FIDA or build on the state's Medicaid Advantage Plus (MAP) program. Alex Kruse from the ICRC described policies in New Jersey that are intended to stimulate integrated managed care without adopting an MMP platform. New Jersey requires all Medicare Dual Eligible Special Need Plans (DSNPs) to operate as "Fully Integrated Dual Eligible Special Needs Plans" (FIDE-SNPs) and offer Medicaid managed long term services and supports. Participants noted that while FIDA's MMP platform offers additional flexibility and opportunities for integrated oversight and administration, the MAP platform would build on existing program infrastructure and allow for a more streamlined start-up, with incremental changes.

Many participants spoke to the need for active provider and beneficiary education to ensure a smooth transition into a new program. Some noted the importance of clear marketing guidance for plans and the need for plans to be involved in the outreach and enrollment process.

DOH is seeking comments on the Future of Integrated Care by Jan. 12, 2018. They are asking stakeholders to submit comments in a template to futureofintegratedcare@health.ny.gov. LeadingAge NY will be submitting comments and asks members to provide their input to Darius Kirstein here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841