MLTC High Cost High Need Survey
Note: On May 30, subsequent to the publication of the article below, DOH issued revised survey forms that include some additional clarifying instructions and no longer request CY 2015 data. The due date is now June 29. The links in the article below are to the revised forms. The May 30th communication from DOH is copied at the very bottom.
The Department of Health (DOH) has issued a request to all Managed Long Term Care (MLTC) plans – including Medicaid Advantage Plus (MAP), Programs of All-Inclusive Care for the Elderly (PACE), and Fully Integrated Duals Advantage (FIDA) – for data on High Cost High Need (HCHN) members. There are two forms: the first (available for download here) requests that plans provide costs and service utilization for members meeting established HCHN criteria, while the second (available here) collects the same data for the most costly 15 percent of members by year and region.
DOH indicates that the data are required to support the evaluation of costs for HCHN members to validate plan encounter data submissions and to meet a legislative requirement to evaluate the HCHN populations. The Department notes that it will be establishing a risk adjustment work group this summer and will use the collected data to inform the risk adjustment process.
DOH requests that the surveys be submitted using the Health Commerce System’s (HCS) Secure File Transfer Application by June 15, 2018, using specified file naming conventions. The notice DOH used to distribute the survey is copied below. Please watch for an announcement of an upcoming webinar that will provide a walk-through of the request. Questions regarding the survey should be addressed to mltcrs@health.ny.gov with "HCHN Data Survey Questions" in the subject line.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841
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DOH Notice:
Dear Health Plan and Association Representatives:
Please find attached a data request related to your MLTC, FIDA, MAP and/or PACE High Cost High Need (HCHN) populations.
In order to support the evaluation of costs for HCHN members in the MLTCP, FIDA, MAP and PACE programs, and to validate plan encounter data submissions, the New York State Department of Health seeks to gain additional information regarding health plans' HCHN enrollment and cost.
The Department has had conversations with CMS regarding addressing the HCHN populations via risk adjustment, risk pools and separate rate cells. The requested data is needed to appropriately address CMS feedback as well as a legislative requirement to evaluate the HCHN populations. Additionally, the Department will be establishing a risk adjustment work group this summer to discuss with Deloitte risk adjustment moving forward and utilizing the collected data to inform the risk adjustment process.
A webinar will be scheduled for the week of May 21, 2018 to walk through the data request and answer questions.
Please review the instructions provided on the [Introduction] and [Notes & Instructions] tabs carefully and provide the requested data/information on the appropriate tabs. A request will not be considered complete without a signed [Attestation] tab. Note, as this information will be an important part of DOH’s continued review of HCHN members, please ensure that this request is completed accurately and timely.
As noted in the instructions, this data request will contain Protected Health Information (PHI). As such, please take necessary steps to comply with HIPAA regulations when transmitting this data. Please submit this data to jmv08 using the Secure File Transfer Application on the HCS. Please post completed templates on or before COB Friday, June 15, 2018.
Please note:
- No PDF files, Excel only
- Do not send password protected files
- Please report Medicaid/Member ID numbers in the Enrollee column
Label your files as follows or they will not be accepted:
PLAN NAME_MLTC Community HCHN Cohort Data Request.xlsx
PLAN NAME_MLTC Community HCHN Top 15th Percentile Data Request.xlsx
Thank you.
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May 30th Message from DOH regarding survey revisions:
Based on feedback received from plans , the Department has revised the HCHN data request templates with changes discussed below. The Department appreciates the effort necessary to submit the requested data. However, discussions with CMS regarding the separate rate cell and/or reflecting the high cost high need population in risk adjustment require demonstrating to CMS significant and reliable data that has been validated. This data will be used to validate the encounter data for this population where plans have voiced feedback where the risk adjustment may not have been properly correlated in the past. Analysis of the encounter data has identified issues as we drill down at the category of service level, so this data will be very useful to help inform discussions on encounter data quality.
Please find attached a revised data request related to your MLTC, FIDA, MAP and/or PACE High Cost High Need (HCHN) populations. Note the following changes:
For both templates, the DUE DATE HAS BEEN REVISED TO FRIDAY, JUNE 29, 2018.
For the MLTC Community HCHN Cohort Data Request,
- The Department is no longer requesting CY2015 data. Please provide data for only CY2016 and CY2017.
- For the “HCHN Cohort End Date” field, please enter “Remains in Cohort” if the member remains in the HCHN cohort as of the end of the filing period as opposed to leaving this field blank.
- The definitions of the 12-24 Hour (now named Continuous Care/Split Shift) and Live-In Home Care cohorts have been clarified.
- The Department is no longer requesting data for the “RUG Group 1-7” cohort.
For the MLTC Community HCHN Top 15th Percentile Data Request,
- Please provide data for only CY2016 and 2017. The Department is no longer requesting CY2015 data.
- The template has been modified to clarify that long stay or permanently placed nursing facility residents should not be included. This phrase has been added to the instructions tab.
Please review the instructions provided on the [Introduction] and [Notes & Instructions] tabs carefully and provide the requested data/information on the appropriate tabs. A request will not be considered complete without a signed [Attestation] tab. Note, as this information will be an important part of DOH’s continued review of HCHN members, please ensure that this request is completed accurately and timely.
As noted in the instructions, this data request will contain Protected Health Information (PHI). As such, please take necessary steps to comply with HIPAA regulations when transmitting this data. Please submit this data to jmv08 using the Secure File Transfer Application on the HCS. Please post completed templates on or before COB Friday, June 29, 2018.
Please note:
- No PDF files, Excel only
- Do not send password protected files
- Please report Medicaid/Member ID numbers in the Enrollee column
You MUST label your files as follows or they will not be accepted:
PLAN NAME_MLTC Community HCHN Cohort Data Request - 20180530.xlsx
PLAN NAME_MLTC Community HCHN Top 15th Percentile Data Request - 20180530.xlsx