1. Managed Long Term Care Plans Mandatory Enrollment Linda Gowdy Home Care Association May 31, 2012 1

2. Managed Long Term Care Models Three MLTC models: 1. Partially Capitated Managed LTC (Medicaid) Benefit package is long term care and ancillary services including home care, unlimited nursing home care 2. Program of All-Inclusive Care for the Elderly (PACE) (Medicare and Medicaid) Benefit package includes all medically necessary services – primary, acute and long term care 3. Medicaid Advantage Plus (MAP) (Medicare and Medicaid) Benefit package includes primary, acute and long term care services (excludes some specialized mental health services) 2

3. Mandatory Enrollment in MLTC and Care Coordination Models 2011 Budget legislation requires: – All dual eligibles who are - Age 21 and older and - In need of community-based long term care services for more than 120 days Must enroll in a Managed Long Term Care Plan or other Care Coordination Model Duals between 18 and 21 remain voluntary 3

4. Mandatory Initiative 1115 Waiver approval needed from CMS before we can start (July, 2012 target) Eliminates the need to score as Nursing Home eligible upon enrollment Definition of community-based long term care services includes: – Personal care services – Home health services – Adult day health care – Private duty nursing 4

5. Initiate Mandatory Enrollment in New York City DOH worked extensively with HRA and Enrollment Broker (Maximus) to develop process for effectively transitioning people. – Will not take place all at once By program By borough Consumer Choice preferred but Auto Assignment for those who do not choose Must ensure continuity of care plan and service provider Significant educational component for people new to system and transitioning Enrollment of those receiving Consumer Directed Personal Assistance services will not begin until September, 2012 5

6. Statewide Mandatory Enrollment There must be a choice of plans in urban areas, at least one in rural counties Upstate expansion will be county by county, as sufficient MLTC plan capacity is developed 6

7. Roll-Out of Mandatory Managed Long Term Care Mandatory Population: Dual eligible, aged 21 and over, receiving community based long term care services for over 120 days, excluding the following: Nursing Home Transition and Diversion waiver participants Traumatic Brain Injury waiver participants Assisted Living Program participants OPWDD waiver recipients 2

8. Voluntary Population In addition to those who must enroll in a Managed Long Term Care Plan, the following people may voluntarily enroll: Dual eligible, 18-21, in need of community based long term care services for over 120 days. Non-Dual eligible, age 18 and older assessed as nursing home eligible. 3

9. Phase I: New York City People New to Service Beginning July, 2012 - Any dual eligible case new to service, fitting the mandatory definition in any New York City county will be identified for enrollment and referred to the Enrollment Broker for action. Enrollment Broker will provide with educational material, list of plans/CCMs, answer questions and provide assistance contacting a plan if requested. Plan/CCM will conduct assessment to determine if eligible for community based long term care. Plan/CCM transmits enrollment to Enrollment Broker 4

10. Transition of Personal Care Recipients People in service will be noticed in batches – Initial batch will be about 2,000 people – Batch may increase as we gain experience and success To avoid disruption, people noticed for transition will have: – At least 120 days left on personal care authorization – At least 120 days left on Medicaid eligibility 10

11. Enrollment Broker Activities Those in service will receive: – Announcement Letter (telling them mandatory is coming) – Letter telling person he/she has 60 days to choose a plan. Mailing will include: Brochure describing MLTC List of Plans (Partial, PACE and MAP) Phone number for Enrollment Broker for assistance – Significant follow-up by phone and mail encouraging individual to choose a plan 11

12. Enrollment Broker Activities (cont.) Enrollment Broker will have plan networks to assist individual to receive services from current/preferred providers At 45 th day, if no choice is made individual will receive letter telling to which plan will be auto- assigned if no choice made by day 60. – Auto-assignment will only be to Partially capitated plans (others would require Medicare enrollment) Enrollment will begin on 1 st of the month If dissatisfied, individual can transfer to another plan (no lock-in) 12

13. Continuity of Care MLTC Plans: – Must have contracts with NYC Home Attendant Vendors to assure that new enrollees will be able to continue with their workers – Must pay the vendor at the HRA rate. Not required to contract with a vendor that will not accept the HRA rate – Must submit a plan for providing continuity of services other than personal care – Are encouraged to augment network providers 13

14. Service Plan Will Continue/ Assessment Required MLTC Plan will continue existing authorized service plan Plan required to conduct assessment within 30 days of enrollment If propose to reduce hours before authorization ends, must issue a Notice of Action – Enrollee has right to appeal rights with aid continuing – Fair hearing rights if appeal is adverse to enrollee 14

15. People in Service Enrollment will be phased-in by service type by borough by zip code in batches. People will be given 60 days to choose a plan according to the following schedule: July 1, 2012: Begin personal care* cases in New York County. August 1, 2012: Continue personal care cases in New York County. September, 2012: Continue personal care cases in New York County and begin personal care in Bronx County; and begin consumer directed personal assistance program cases in New York and Bronx counties. October, 2012: Continue personal care and consumer directed personal assistance program cases in New York and Bronx counties and begin Kings County. 5

16. Phase 1 (continued) November 2012: Continue personal care and consumer directed personal assistance program cases in New York, Bronx and Kings counties December 2012: Continue personal care and consumer directed personal assistance program cases in New York, Bronx and Kings Counties and begin Queens and Richmond counties January 2013: Initiate enrollments citywide of long term home health care program, home health over 120 days, adult day health care program and private duty nursing cases not enrolled under personal care case activity. 6

17. Phase 1 (Cont.) February 2013 and until all people in service are enrolled: Personal care, consumer directed personal assistance program, long term home health care program, home health over 120 days, adult day health care program and private duty nursing cases in New York, Bronx, Kings, Queens and Richmond Counties *Individuals receiving personal care while enrolled in Medicaid Advantage will begin MLTC/CCM enrollment in January, 2013. 7

18. Next Phase(s) As plan capacity is established, dually eligible community based long term care service recipients will be enrolled as follows: Phase II: Nassau, Suffolk and Westchester Counties – Anticipated January 2013. Phase III: Rockland and Orange Counties – Anticipated June 2013. Phase IV: Albany, Erie, Onondaga and Monroe Counties – Anticipated December 2013. Phase V: Other counties with capacity – Anticipated June 2014. 9

19. Final Phase Phase VI: Previously excluded dual eligible groups contingent upon development of appropriate programs: Nursing Home Transition and Diversion waiver participants Traumatic Brain Injury waiver participants Assisted Living Program participants 11