DOH Planning Risk Score Update to MLTC Rates
The Department of Health (DOH) intends to update the risk scores used to calculate Managed Long Term Care (MLTC) plan rates for the second half of the 2022-23 rate year. Rates would be updated for the period Oct. 1, 2022 through March 31, 2023 to reflect data from assessments submitted between Oct. 1, 2021 and Sept. 30, 2022. This update would impact all MLTC plans, including Partially Capitated and Medicaid Advantage Plus (MAP) plans as well as Programs of All-Inclusive Care for the Elderly (PACE programs).
DOH is urging MLTC plans to ensure that all members have a completed assessment for the period of Oct. 1, 2021 through Sept. 30, 2022 so that they would be captured in the updated risk scores. Any backlog of assessments should be as complete as possible by Sept. 30, 2022, which will be the cutoff date for submissions to be included in the calculation. Given this timing, DOH notes that while the calculations of the updated risk scores will be completed after October, the risk score changes will be reflected retrospectively in rates effective Oct. 1, 2022 through March 31, 2023.
Members may recall that due to interruptions in the assessment process, availability of community assessment data was limited during the pandemic, leading Deloitte and DOH to incorporate estimates into the most recent risk score calculations. DOH intends to maintain those risk scores in the April through September 2022 rates.
Further discussion on this issue, including the enrollment snapshot date, is expected at the upcoming June 13th Finance Meeting.
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841