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MLTC Roll-Out –FIDA NEWS - Training Reminder Dec. 3rd on FIDA, Plan list, roll-out schedule, Pooled Trusts Again Allowed for Married MLTC Enrollees.

25 Nov, 2014

KEY CONTACTS

  • State Complaint Number for MLTC Problems - 1-866-712-7197  or
  • For MLTC enrollment complaints - call NY Medicaid Choice -
    • 1-855-886-0570 (Advocates line)
    •  1-888-401-6582 (Consumers line)  
  • Request Conflict-Free MLTC Assessment AFTER  approved for Medicaid call NY Medicaid Choice at 1-855-222-8350.
  • FIDA - to OPT OUT call NY MEDICAID CHOICE at 1-855-600-3442  (after Dec 1st)
  • ICAN - OMBUDSPROGRAM FOR FIDA & MLTC  (After Dec. 1st)   Phone:  844-614-8800    
    • TTY Relay Service:  711   Website:        icannys.org
  • State Webpage on MLTC Policy -- MRT 90: Mandatory Enrollment Managed Long Term Care

New in November 2014

  • Last Call for Registration for CLE/ Training Program on FIDA and MLTC  - December 3, 2014  1 PM - 5 PM 

  • POSTED 11/25/14 - Click here to download final version of "FIDA Announcement Notice" being sent by State Dept. of Health to over 110,000 MLTC members in NYC and Nassau County.  Letter being sent on a rolling basis in batches.  (This version includes attached list of FIDA plans for both NYC and Nassau County.  Client will only receive the one for their district.)     NOTE:  DOH failed to include crucial information - rejecting consumer advocacy, including:
    • Right to Opt Out of FIDA
    • Fact that you will be passively enrolled in FIDA if you don't opt out -- and when
    • Says FIDA is free but doesn't explain that you still owe Medicaid Spend-down, if you have one - a source of confusion
    • Nothing clarifying that must obtain all medical and long term care in-network from plan, ...
    • and more..  Compare final notice with edits proposed by consumers to earlier version of notice
    • POSTED DOCUMENT includes inserts about ICAN - the new OMBUDSPROGRAM and how to request info in other languages.
  • More info on how FIDA will roll out -

    • SEE NYLAG Fact Sheet on FIDA  with list of plans in NYC and Nassau County (Region I - first to roll out)

    • List of the 22 FIDA contracts is here published by Crain's NY.  Until now, State only released list of 25 plans being considered for FIDA,but not the final list of 22 plans.   Many plans are listed under different corporate names.   NYLAG has compiled a list of the 22 plans showing which MLTC and Medicaid Advantage Plus plans they are affiliated with in each county in the Demonstration area - NYC, Long Island and Westchester.  Note that some plans do not operate in every borough in NYC.

  • DOH Policy & Planning update dated Oct. 16, 2014  has important info: 
    • ROLL-OUT SCHEDULE - When MLTC recipients in Region I (NYC and Nassau) will receive the "announcement" letter starting December 2014 them telling about FIDA,  and when will they be passively enrolled into FIDA plans - will be on a rolling basis depending on when they renew Medicaid for the year.  Passive enrollment will happen over FOUR MONTHS beginning April 2015   Region II (Suffolk and Westchester) won't start receiving letters until March 2015.

    • NEWS that current NURSING HOME RESIDENTS will NOT be passively enrolled into FIDA plans!  Only NEW people who first become PERMANENT NH residents in 2015 will be passively enrolled but not til August 2015.  Only people who have approved for Institutional Medicaid after  the 5-year lookback has been  approved will be subject to passive enrollment.  They will first receive letters giving them at least 90 days to select a FIDA plan on their own or to OPT OUT, and only at the end will be passively enrolled.

  • NOV.1st -- Conflict-Free Assessment required before MLTC enrollment in Brooklyn, Queens, Staten Island and Nassau County.  See Sept. - Oct. 2014 news below.   Must call NY Medicaid Choice to request assessment before you can enroll in an MLTC plan, in all of NYC and Nassau County. To schedule an evaluation, call 855-222-8350.

  • Niagara, Madison, Oswego become mandatory for MLTC.  See chart below for all counties schedule.Front door closed for applying for personal care at local DSS on Oct. 20th.
  • State issues new directive on Spousal Impoverishment protections, rescinding August 2014 directive and reinstating earlier directives.  As a result, pooled trusts are again allowed for couples where one spouse is in MLTC.   This is temporary - awaiting clarification from CMS.   Suffolk County and  any other county must retroactively re-budget every client, again allowing the pooled trust.  See this article

New in September - October 2014

  • OCTOBER 1, 2014 - Conflict-Free Evaluation and Enrollment Center (CFEEC) OPENS in MANHATTAN AND BRONX

On Sept. 30, 2014, DOH issued MLTC Policy 14.06: Implementation of the Conflict-Free Evaluation and Enrollment Center (CFEEC)  that announces that the CFEEC is open in Manhattan and the Bronx.  Anyone approved for Medicaid after Oct. 1, 2014 in those boroughs who is seeking Managed Long Term Care will need to first contact NEW YORK MEDICAID CHOICE and request a CFEEC assessment.  If that assessment finds the person eligible for MLTC, then the person can enroll in an MLTC plan.  To schedule an evaluation, call 855-222-8350.

SEE NEW YORK MEDICAID CHOICE WEBSITE ON CFEEC - http://nymedicaidchoice.com/ask/conflict-free-evaluation-and-enrollment-center

This is being implemented pursuant to #28 of the Special Terms and Conditions, which is CMS's approval of the State's 1115 waiver to implement mandatory MLTC, DOH has established a conflict-free assessment system for all voluntary enrollments into MLTC, MAP and PACE effective October 1, 2014.

Currently, private MLTC plans are responsible for determining eligibility for Medicaid-covered long-term services and supports (LTSS).  This creates an intrinsic conflict of interest, because plans have a financial stake in avoiding high-cost members and attracting low-cost members.  To partially reduce this conflict, DOH will prohibit MLTC plans themselves from enrolling new members.  Instead, they will be required to refer prospective members to New York Medicaid Choice (aka Maximus), currently the enrollment broker for Medicaid managed care in NY.

Under this program, NY Medicaid Choice will establish a Conflict-Free Evaluation and Enrollment Center (CFEEC) to schedule and conduct initial assessment visits in the home or facility by a nurse (employed by or under contract with the CFEEC).  Using the Uniform Assessment Tool, the CFEEC makes the determination of eligibility for Medicaid LTSS.  If the CFEEC determines that the applicant is ineligible for Medicaid LTSS, it will send a written notice with appeal rights.  If the CFEEC approves the applicant, then any MLTC, MAP, PACE or FIDA plan must accept the applicant's enrollment.  If the plan disagrees with the CFEEC's determination of eligibility, it may pursue a dispute adjudication procedure via Maximus and DOH.

The CFEEC will be rolled out in phases:

  • Region 1 – October 2014: New York & Bronx
  • Region 2 – November 2014: Kings, Queens, Nassau, & Richmond
  • Region 3 – February 2015: Westchester & Suffolk
  • Region 4 - March 2015: Columbia, Dutchess, Putnam, Rockland, Orange, Ulster, Greene, Sullivan, Warren, Washington, Saratoga, Fulton, Montgomery, Schoharie, Schenectady, Albany, Rensselaer, Erie, Monroe, Onondaga
  • Region 5 – April 2015: Tompkins, Cortland, Tioga, Broome, Chenango, Otsego, Delaware, Wayne, Ontario, Livingston, Seneca, Cayuga, Yates, Schuyler, Chemung, Steuben, Chautauqua, Cattaraugus, Allegany, Wyoming, Genesee, Orleans, Niagara)
  • Region 6 – May 2015: Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison, St. Lawrence, Franklin, Clinton, Essex, Hamilton)

Source: N.Y. Dep't of Health, FIDA and MLTC Policy and Planning Update Presentation (September 11, 2014, on file with NYLAG).

Will this delay enrollment into MLTC?  Probably.  MLTC plans may not accept an enrollment without confirmation from CFEEC that you are MLTC-eligible.  That confirmation is valid for 60  days.   The State FAQ (Q13) says the CFEEC assessment can be done while Medicaid application is pending, but since a Medicaid application can take more than 60 days - it can be risky.  It is also unclear whether the consumer must only sign an MLTC plan enrollment form within 60 days of the CFEEC assessment, or must actually be enrolled in the plan by that date - the difference can be significant.

See new documents available from NYS DOH on the Conflict-Free Evaluation and Enrollment Center (CFEEC):

DOH has rolled out mandatory MLTC in additional counties.  Here is the updated timeline:

Month New Schedule "MLTC Announcement" letter sent 60-day "Choice" letters sent "Front door" closed - no new Personal Care applications at local Medicaid office
9/2012 - 12/2013

Albany, Erie, Monroe, Nassau, Onondaga, Orange, Rockland, Suffolk, Westchester

Jan 2014 Columbia, Putnam, Sullivan, Ulster April 2014 early May 2014 May __  2014
June 2014 Cayuga, Herkimer, Oneida, and Rensselaer Week of May 23, 2014 week of June 2, 2014 May 30th
July 2014 Greene, Saratoga, Schenectady, and Washington Week of June 30th Week of July 14 July 7, 2014
August 2014 Dutchess, Montgomery, Broome, Fulton, Schoharie Week of Aug. 29th Week of Sept. 22nd September 8, 2014
September 2014 Delaware, Warren Sept. 15th Oct. 1st Sept. 22nd 
October 2014 Niagara, Madison, Oswego Week of Oct. 27th Oct. 20th
November 2014 Chenango, Cortland, Livingston, Ontario, Steuben, Tioga,  Tompkins, Wayne
December 2014 Genesee, Orleans, Otsego, Wyoming
January 2015 Chautauqua, Chemung, Seneca, Schuyler, Yates, Allegany, Cattaraugus
February 2015 Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, St. Lawrence

Source:   NYS DOH  Updated 2014-2015 MLTC Transition Timeline (PDF, 88KB)  (MRT e-mails)

  • Mandatory MLTC/MMC for Nursing Home Residents Postponed Again

While we have no written confirmation of this fact, DOH staff have stated that the initiative to require all nursing home residents to enroll in Medicaid managed care plans has been once again postponed, this time to January 2015.  Further updates may be posted here. 

New in July 2014

  • Four more Upstate Counties Start Mandatory MLTC enrollment 

Greene, Saratoga, Schenectady, and Washington Counties --  The mailing of announcement notices to the fee for service population began  during the week of June 30th, and the mailing of mandatory letters began  during the week of July 14, 2014, giving 60-days to select a plan before being randomly assigned to an MLTC plan.

Beginning July 7, 2014, the "front door" is closed -- the County DSS no longer accepts applications for personal care or CDPAP.  Applicants for those services, who have obtained Medicaid by applying at their local DSS,  must select an MLTC plan, PACE or MAP plan -- and may enroll directly through the plan..    Contact New York Medicaid Choice  1-888-401-6582.

“The Office of Health Insurance Programs has not received approval from CMS to transition the Nursing Home benefit and population into managed care.  We continue to negotiate the terms of this transition and therefore the implementation date has been extended to August 1, 2014.  We will modify the current timeline reflected in the Nursing Home Policy Paper and will re-post it to the web.  We apologize if the delay causes any disruption and will inform you when the approval is obtained.”

In New York City, Long Island and Westchester County, mandatory enrollment in managed care for new, permanent residents has been postponed from March 1st to June 1 and now to August  1, 2014. Other areas of the state that were scheduled to make the transition six months later are presumably now scheduled to begin mandatory enrollment on Jan. 1, 2014,  The delay provides the state with additional time to address some of the concerns that LeadingAge NY and other associations have raised regarding the transition. On March 14, 2014, NYLAG and six other consumer advocacy organizations in NYS sent a letter to the federal Medicaid agency, CMS and to the State Dept. of  Health asking them to slow down the expansion of Medicaid managed care to include all new nursing home residents who become permanently placed in nursing homes after April 1, 2014

New in June 2014

Nursing Home Resident Transition to Managed Care Delayed One Month to July 2014 downstate, Dec. 14 upstate

According to a State DOH Alert  Leading Age NY web posting on June 3, 2014, the Department of Health has delayed for one month the mandatory enrollment in managed care plans of new, permanent nursing home residents on Medicaid.  The state has yet to receive approval from the Centers for Medicare and Medicaid Services for its plan to transition the nursing home population and benefit into Medicaid managed care.

New in May - April 2014

  • May 23, 2014 - FOUR MORE UPSTATE COUNTIES GOING MANDATORY -  From DOH:  "The Department has moved forward with next step in the transition of fee for service community based long term care services to Managed Long Term Care in Cayuga, Herkimer, Oneida, and Rensselaer Counties.  

    The mailing of announcement notices to the fee for service population began this week and the mailing of mandatory letters will begin during the week of June 2, 2014. 

    Beginning May 30, 2014, consumers seeking Community Based Long Term Care Services will be directed to New York Medicaid Choice for education of Managed Long Term Care options in their county. The number that should be used is 1-888 401-6582.

    The Department remains on track with the remainder of the planned transition, and we anticipate moving Greene, Saratoga, Schenectady, and Washington to mandatory MLTC during the month of June.

    Questions specific to the transition may be directed to MLTCTRANS@health.state.ny.us.

  • May 22, 2014 State posts directive requiring MLTC plans to assess potential enrollees who are in nursing homes - whether they are in nursing homes temporarily or permanently.   See  MLTC Policy 14.04: MLTCP Potential Enrollee Assessments ,  THe MLTC plan must conduct the assessment within 30 days of the referral.  The plan may also require an in-home assessment to make sure the home environment is safe, but may not require the prospective member to travel to their home for the assessment.  A family member or other person may give access. NYLAG, Disability Rights New York and other advocates pressed for this directive for over a year, since the MLTC plans' refusal to assess nursing home residents prevented them from returning to the community, violating their rights under the ADA and Olmstead.

  • May 5, 2014 - State issues directive that takes a step in fixing computer coding problems that delay enrollment in MLTC.  NYS DOH GIS 2014 MA/10 -- 06 to 30 Conversion for MLTC Enrollees.  An unexpected but serious problem with implementation of MLTC has been long delays in enrolling in an MLTC plan, even after an individual has endured the long process of applying for Medicaid.  Problems are especially bad for people who apply for Medicaid and are determined to have a spend-down or "excess income."  Their Medicaid coverage does not become effective until they submit medical bills that meet the spend-down, according to complicated rules explained here  and on the State's website.   Many people applying for Medicaid to pay for long-term care services can't activate their Medicaid coverage until they actually begin receiving the services, because they don't have enough other medical bills that meet their spend-down.  This creates a catch-22, because they cannot start receiving MLTC services until Medicaid is activated.  Until their Medicaid is activated, the Medicaid computer is coded to show they are not eligible.  As a result, an MLTC plan could refuse to enroll them -- because they do not have active Medicaid. To address this problem,  the State is trying a few steps.
    • First, applicants must request Eligibility CODE 06 if they are seeking MLTC.  See Medicaid Alert dated July 12, 2012. THis gives them "Provisional Medicaid" eligibility so that an MLTC plan sees they have Medicaid and will enroll them.
    • Second, until now, the MLTC plan had to then request that HRA/DSS "convert" their eligibility to CODE 30, which is full Medicaid rather than provisional Medicaid.   In NYC, MLTC plans were required to fax HRA a "conversion form and  package" to activate Medicaid when the consumer has a spend-down.  Download Conversion cover sheet here.  Despite extensive education by HRA, many plans failed to do this.
    • NOW, in May 2014, this new GIS explains that as long as CODE 06 was used on the application, the code will automatically change to CODE 30 full eligibility when the MLTC plan enrolls the individual.  So.. no "conversion" form should be necessary.
  • "Medicaid Shift Fuels Rush for Profitable Clients" - New York Times reporter Nina Bernstein uncovers disturbing behavior among the Managed Long Term Care plans early in the implementation of mandatory MLTC, as they competed for market share of new enrollees  (published May 9, 2014)

  • Webinar available for online viewing  explaining Managed Long Term Care and the upcoming expansion to require new nursing home residents to enroll in MLTC plans, or, for those without Medicare, into mainstream managed care plans.  The webinar was recorded April 24, 2014 and was conducted by Valerie Bogart and David Silva of the Evelyn Frank Legal REsources Program at NYLAG.

You can also view and listen to a recording of the entire webinar at this link:

https://attendee.gotowebinar.com/recording/1348252302283983105 (2.25 hours)

The PowerPoint and Appendix used in the webinar are available at the following links:

PowerPoint: http://wnylc.com/health/download/474

Appendix: http://wnylc.com/health/download/473

  • FOUR NEW COUNTIES start mandatory enrollment -- Columbia, Putnam, Sullivan, Ulster   THis week - week of April 15th  adult dual eligibles  receiving Medicaid personal care, private duty nursing, consumer directed personal assistance, certified home health aide care, adult day health care and Lombardi services began receiving the:
  1. "Announcement" letter from the State Dept. of Health that explains the changes, but does NOT YET  require the individual to join a plan. See also Spanish version -- Aviso importante de Medicaid  
  2. 60-Day Choice letter - In early May, they will receive a letter from NY Medicaid Choice will be mailed (MAXIMUS)--Form Letter to Personal Care/Home Attendant recipients  -- the enrollment broker under contract with the State Dept. of Health, requiring them to join an MLTC plan (or PACE or Medicaid Advantage Plus) within 60 days, or they will be randomly assigned to an MLTC plan.  The letter will include:
    •  Guide to MLTC, and
    • List of plans by County and Type of Plan (Updated March 2014)-   eventually you can download the list for each region at this link under "Long Term Care plans' by region  - but not posted yet for this region.  Full contact list available here.  Here are the plans available in the 4 new counties with enrollment as of Feb. 2014.  A blank space means

Ulster

Sullivan

Columbia

Putnam

No. enrolled as of Feb. 2014 62 34 15 36

FIDELIS CARE AT HOME

x x x x

VNS CHOICE

x x x x

WELLCARE

x

HAMASPIK CHOICE

x x

ARCHCARE

 

 

 

x

  •            The "front door" closes in these counties on APRIL 21st, meaning the local Dept. of Social Services will no longer accept requests for personal care or CDPAP services, and enrollment in an MLTC plan is required for any of the other community-based long term care services. 

  • Mandatory enrollment of nursing home residents in MLTC and mainstream Managed Care plans still has not been approved by CMS as of April 15, 2014, but is still on track to be implemented June 1, 2014.  SEe more in this article.

New in January 2014

While mandatory enrollment is moving forward in 4 new upstate counties in January (Albany, Erie, Onondoga and Monroe - see more below) the State has released the proposed roll-out schedule for mandatory MLTC enrollment in upstate counties  during 2014, subject to approval by CMS.  Schedule officially published in GIS MA 2014/04 (Feb. 3, 2014):

To see what plan choices exist now in these counties, including MLTC, PACE, and MLTC plans, see this Statewide chart   (showing enrollment as of March 2014) see also this chart organized by insurance company, which sponsors the plan, showing which different MLTC/MAP/PACE plans are offered by the company as of Dec. 2013.  Shows which companies are launching FIDA plans in 2014.  Presumably more plans will be announced in the next months.

New in December 2013

 PLEASE SEE this article for earlier postings.  

MLTC Updates - 2012 - 2013

 


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