The State Dept. of Health has moved ahead to implement the changes enacted in the State Budget in late March 2011. The changes are generally described in this article . Here is information on the status of implementation of some of the changes -- some of which require a "waiver" from the federal Medicaid agency, CMS, and/or require the State to amend its State Medicaid plan, which also requires CMS approval.
The State submitted a request to amend the 1115 waiver to CMS on April13, 2011. The State's letter to CMS, description of the changes, and Timeline for proposed implementation are all posted at http://www.health.ny.gov/health_care/managed_care/appextension/ -- all under the first heading labeled Amendment to Implement Medicaid Redesign Team Changes to the 1115 Waivers.
This initial expansion would not require Medicare beneficiaries to enroll in a Medicaid Managed Care plan. The initial expansion would mandate these populations and services .. for later groups, see the entire Phase-In Schedule proposed by DOH. Note that all of this is subject to CMS approval, which is pending.
7/1/11 - Recipient Restriction Program individuals enrolled
8/1/11 - Personal Care services will no longer be "carved out" from the Medicaid managed care benefit package. Those individuals who otherwise are mandated to enroll in a Medicaid managed care plan and who now receive Personal Care (home attendant in NYC) approved by their local Dept. of Social Services (CASA) would now have these services authorized by their managed care plan. SEE MORE INFORMATION IN THIS NEWS ITEM posted July 29, 2011
DOH issued this "GIS" Directive June 7, 2011 -- 11LTC008 - Personal Care Services Changes for Non-Dual Eligible Persons Participating in Mainstream Managed Care Programs(PDF, 20KB, 2pg.)
Note that those receiving consumer directed personal assistance program (CDPAP) willNOT be required to enroll in a Medicaid managed care program in August 2011. They will be required to enroll in July 2012.
About 5800 Medicaid recipients statewide (we heard about 4200 of these live in NYC) who now receive personal care services will be affected by this and will be required to enroll in a Medicaid Managed Care plan.
SEE MORE INFORMATION IN THIS NEWS ITEM posted July 29, 2011.
10/1/11 and later -- see Phase-In Schedule
For information on how Medicaid Managed Care has worked prior to these changes, see this article.
The state budget will mandate, subject to CMS approval, that all personal care, long-term home health agency (CHHA) recipients and applicants, and other home care recipients to be designated by DOH, enroll in a Managed Long Term Care Plan.
DOH requested CMS approval for this change in the same April 13, 2011 1115 waiver request with which it requested expansion of Medicaid managed care, described above. See ttp://www.health.ny.gov/health_care/managed_care/appextension/ -- all under the first heading labeled Amendment to Implement Medicaid Redesign Team Changes to the 1115 Waivers. The details on the Managed Long Term Care expansion request begin at Page 3 of the Summary of MRT changes.
State DOH has already revised its instructions to providers to include these changes in equipment and supplies.
The above updates are posted at http://www.emedny.org/providermanuals/DME/communications.html.
Also see this Procedure Codes Manual for DURABLE MEDICAL EQUIPMENT, ORTHOTICS, PROSTHETICS, AND
SUPPLIES, updated in May 2011.
See other documents posted on the status of changes proposed by the DOH Medicaid Redesign Team and its current activities, public meeting schedule, etc. See http://www.health.state.ny.us/health_care/medicaid/redesign/. Among recent postings is MRT Proposals Project Management Plan
This news item posted by Selfhelp Community Services, Inc.