1. Care Management for All
DOH Update for Long Term Care
Mark Kissinger
Director, Department of Long Term Care
Office of Health Insurance Programs
New York State Department of Health
June 29, 2016 NYSHFA * NYSCAL * NY-AALNA 2016 Annual Convention

2. Agenda Managed Long Term Care (MLTC) Update
Phase IV: Assisted Living Program (ALP) Transition to Managed Care
Home and Community-Based Services (HCBS) Final Rule
MLTC Resources

3. MLTC Statewide Enrollment*
Number of Plans Statewide Actively Enrolling: 66
Total Enrollees Statewide: 171,458
FIDA: 17
FIDA IDD: 1 F
Demonstration
counties only
Medicaid Advantage
Plus (MAP): 7
MAP 5,728
All Serving NYC
Program of All-Inclusive Care for the Elderly (PACE): 9
2 Serving NYC
Partially Capitated: 32
23 Serving NYC
*Based on June 2016 Partial/MAP/PACE enrollment reports and the June 2016 FIDA enrollment report

4. MLTC Transition The following programs have been moved into MLTC:
Long Term Home Health Care Program (LTHHCP)
Consumer Directed Personal Assistance Program (CDPAP)
Personal Care Services (PCSP)
Home Health Services
Adult Day Health Care
Private Duty Nursing
The following programs are planned to be moved to MLTC in the near future:
Assisted Living Program (ALP) – December 2016
Nursing Home Transition and Diversion Waiver (NHTD) – January 2018
Traumatic Brain Injury Waiver (TBI) – January 2018

5. MLTC Enrollment Phases
All counties in New York State have been approved for MLTC transition.
Phase I: The five counties of New York City, New York, Kings, Bronx, Queens, and Richmond Counties.
Phase II: Nassau, Suffolk and Westchester Counties.
Phase III: Rockland and Orange Counties.
Phase IV: Albany, Erie, Onondaga, and Monroe Counties.
Phase V: Other upstate counties with capacity, as approved.
Phase VI: Previously excluded dual-eligible groups contingent upon development of appropriate programs, including ALP. Currently in progress.

6. Phase VI: Care Management for ALP
In keeping with the MRT Care Management for All goal, Assisted Living Program (ALP) participants will be transitioned into managed care programs.
The Care Management for All approach will improve benefit coordination, quality of care, and patient outcomes over the full range of health care, including mental health, substance abuse, developmental disability and physical health care services.
To receive long term care services, ALP participants will be offered care through:
Managed Long Term Care (MLTC), or
Medicaid Managed Care (MMC)

7. Phase VI: Current ALP Environment
There are currently 130 licensed Assisted Living Programs (ALPs) throughout New York State. 29 59 24 18

8. Phase VI: MLTC Transition for ALP
DOH is coordinating meetings with associations and the ALP transition workgroup meetings will be scheduled for dates in July and the fall.
Subgroups may be created to more carefully explore specific issues that pertain to the transition.

9. Phase VI: MLTC Transition for ALP
2. Approval of ALP “transition plan” by CMS
3. Announcement sent to each ALP participant
4. Mandatory Enrollment commences
5. Services to begin
1. An ALP “transition plan” will be established
Phase VI: MLTC Transition for ALP
Moving into Managed Care

10. Phase VI: ALP Transition Issues
Rates
Rates are currently being analyzed with the intent of a possible adjustment
Care Management
Care coordination responsibilities between ALP and MCO

11. HCBS Final Rule
Once the program makes the MLTC transition, ALPs will be required to comply with Home and Community-Based Services (HCBS) Final Rule.
Key Provisions:
Regulates appropriate home and community-based settings for residential and non- residential Medicaid waiver programs (1915[c], 1915[i], 1915 [k] and 1115):
Aligns policies and procedures for individuals in need of home and community- based services across disability populations using three distinct Medicaid funded authorities (1915[c], 1915[i], 1915 [k])
Establishes new person-centered planning and conflict of interest requirements
Establishes public notice process for substantive changes in services or rates, new effective dates, new CMS monitoring and compliance tools.

12. HCBS Requirements
Ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint
Optimizes individual initiative, autonomy, and independence in making life choices
Facilitates individual choice regarding services and supports, and who provides them

13. Allowable Home and Community-Based Settings
Are integrated in and support access to the greater community
Provide opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources
Ensure the individual receives services in the community to the same degree of access as individuals not receiving Medicaid HCBS
Are selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting
Person-centered service plans document the options based on the individual’s needs, preferences; and for residential settings, resources

14. Additional Provisions for Provider Owned - Controlled Settings
Unit is owned, rented, occupied - legally enforceable agreement
Same responsibilities/protections from eviction all tenants receive
Privacy in sleeping or living unit
Units have lockable entrance doors
Individual and appropriate staff have keys to doors
Choice of roommates in shared units
Freedom to furnish and decorate sleeping or living units
Freedom and support to control schedules and activities
Access to food and visitors at any time
Setting is physically accessible

15. MLTC Resources for Consumers: ICAN
Once in MLTC, a participant has access to the Ombudsman, known as the Independent Consumer Advocacy Network (ICAN).
ICAN is an independent, conflict-free entity that provides individuals free assistance in accessing care, filing grievances, appealing adverse decisions, and understanding and exercising rights and responsibilities.
There are 60 ICAN locations throughout NYS, at which Participants can obtain in- person assistance.
The call center receives calls from the entire state.
The Ombudsman program contract was awarded to Community Service Society of New York, a network of not-for-profit organizations.
ICAN can be reached by calling or online at

16. Other MLTC Resources
Consumers, family members, and representatives have the right to file a complaint with any of the following:
Health Plan Member Services Department
NY Medicaid Choice
NYSDOH by phone or in writing
Consumer has the right to appeal a plan decision and the right to a Fair Hearing:
Timeframes in model contracts, provider manuals, member handbooks, and determination notices.
External appeal available for medical necessity denials.

17. 40
QUESTIONS?

18. Contact us: MRT website:
MLTC