Alert 9/19/2012 The purpose of this Alert is to inform Community Based Organizations, Client
Representatives, Certified Home Health Agencies and other providers that the waiver
“look-alikes” exemption for managed care ended September 1st.

This exemption had been available for consumers who have the same characteristics and needs as
consumers enrolled in Medicaid waiver programs such as Traumatic Brain Injury,
Care at Home, Home and Community Based Services for the Developmentally
Disabled, and the Nursing Home Transition Waiver, but are not enrolled in a waiver
program.

Such consumers may decide they now want to apply for a waiver program or
designation as developmentally disabled. Because this process may take more than
30 days, SDOH has decided to allow an exemption for up to six months for non -
dually eligible consumers who are in the process of applying for a waiver program or
designation as developmentally disabled. To qualify for this exemption, consumers
must call NY Medicaid Choice at 800-505-5678, to inform staff that they are applying
for waiver services.

This list was released by DOH to the Long Term Care Community Coalition in April 2013, in response to a Freedom of Information request

8-13-13 MICSA Alert detailing the housekeeping conversion process to facilitate consumer disenrollment from MLTC plans to HRA.

NYLAG training materials, including PowerPoint and Appendix, on Medicaid Managed Long-Term Care in New York. As of 6/21/2013, the latest version of the presentation given by the Evelyn Frank Legal Resources Program 50 times in the last year.

Changes in how Medicaid managed care recipients obtain transportation to doctor or other medical providers in non-emergencies

Letter from Jason Helgerson to MLTC Plans responding to reports of fraudulent enrollment of people not medically eligible for MLTC from social adult day care centers.

HRA Alert announcing mandatory enrollment of LTHHCP consumers in managed care and managed long term care plans. The first letters are expected to be sent in early May. Eligible consumers have the option of enrolling in other waiver programs.

Data compiled by Evelyn Frank Legal Resources Program from MMCOR cost reports filed by plans with State Dept. of Health, released through Freedom of Information Request. Data for CY 2011

MLTC Plans (Partial Capitation) by Hours of Personal Care & Home Health Aide Services Provided – 2011 (In order of highest percentage of cases > 480 hours/month)(All solely NYC unless otherwise indicated). "Member months" means month in which plan reported providing a member with Personal Care or Home Health aide services. Since many members do not receive these services for an entire calendar year, this figure is more accurate than stating the total number of members who received the specified amount of hours.

Data compiled from MMCOR Reports filed by plans and disclosed to Evelyn Frank Legal Resources Program thru a FOIL request.. Full calendar year 2011.

Derived from Quarterly Managed Medicaid Cost and Operating Reports (MMCOR) data with the State Department of Health for 2011, obtained through FOIL request by NYLAG, analyzed by David Silva, EFLRP.