Managed Program Updates

Deanna Stephenson

NYSHFA / NYSCAL met with DOH to discuss the progress moving forward the MLTC 3 Month Benefit Limit to Fee for Service. The Department has a team that is concentrating on the process of moving the benefit and once the process is confirmed, they will ask approval from CMS. The Department did not communicate a specific timeline but expressed their desire to have the benefit moved over to Fee for Service before the end of the year. Again these discussions with The Department continue to be fluid.

While attending the monthly Managed Care Policy and Planning Meeting today please find updates on other managed care program initiatives affecting our industry.

  • “Able New York” is a Multi – Agency Initiative at the Governor’s direction to emphasize enhanced accessibility to State services. The Department will issue guidance on existing requirements and programs that emphasize choice, this will include A Dear Administrator reminder to all nursing facilities requesting them to provide assistance to any resident that wishes to return to the community. The initiative will also distribute education about MLTC Housing Disregard to nursing homes, adult homes, local governments, and MLTC plans. Under this program The Department will seek to incentivize nursing home discharges by developing a quality metric that rewards facilities discharging long stay residents to the community.
  • Social Adult Day Care – The Department will issues guidance in September that will highlight various recommendations to efficiently utilize the Social Adult Day benefit.
  • LHCSA Contract Limitations – Draft guidance was released in July regarding the number of licensed home care services a Partial Capitation plan may have in its network. Further and final guidance is expected to be released from The Department this month.
  • MLTC VBP Program & Nursing Home Participation – The Department has released updates to the VBP program and can be found in the VBP Resource Library. Please refer to the below link for further information.

NYSHFA / NYSCAL continues discussions regarding the different managed program initiatives that are being rolled out by The Department. We will continue to update our membership of any new information.

Deanna L. Stephenson
Director, Managed Programs
518-462-4800 x16