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New Resources Available for Community Services Providers and Managed Care Plans

New resources are available to assist home and community-based services (HCBS) providers and managed care plans to identify and evaluate opportunities to address the non-medical needs of beneficiaries through Medicaid managed care social determinants of health (SDH) interventions and Medicare Advantage supplemental benefits.

Under New York State's Medicaid waiver and Value-Based Payment (VBP) Roadmap, Medicaid managed care plans are required to shift their provider contracts to Level 2 and 3 VBP arrangements that include approved SDH interventions and contracts with community-based organizations (CBOs) that do not bill Medicaid. The State Department of Health (DOH) recently published a list of the SDH interventions it has approved for managed long term care (MLTC) plans, Programs of All-Inclusive Care for the Elderly (PACE), and mainstream managed care. The MLTC and PACE SDH interventions are varied and address issues such as financial literacy and scam avoidance, asthma and diabetes self-management, social isolation, homelessness and housing instability, and advance care planning education. In addition, the Department's SDH web page offers a link to a Return on Investment Calculator for SDH interventions as well as an updated CBO Directory, webinars, and contract templates.

The Medicare Advantage program is also recognizing the importance of SDH and other non-medical supports by expanding the supplemental benefits that plans are authorized to offer. Additional detail on the expansion of supplemental benefits is available here and here. In response to this initiative, LeadingAge National has launched a new toolkit on its Center for Managed Care Solutions & Innovations website that will help members understand and evaluate opportunities to provide HCBS and other special supplemental benefits for chronically ill individuals through Medicare Advantage plans. The toolkit includes the following:

  • Medicare Advantage Engagement Strategy Checklist;
  • Medicare Advantage Supplemental Benefits Explained;
  • Medicare Advantage Plan Engagement Tips;
  • A Step-by-Step Guide for Evaluating Medicare Advantage Activity in Your Market;
  • Telling Your Story template.

An article with more detail on the Medicare Advantage Supplemental Benefits Toolkit is available here.

LeadingAge NY members that provide community-based services may find opportunities to offer these types of services through contracts with both Medicare Advantage plans and Medicaid MLTC and mainstream plans.

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