Situation Report | February 14, 2022
Last week, the State’s Department of Health’s (DOH’s) Office of Health Insurance Programs hosted its monthly Medicaid Managed Care Policy and Planning meeting and provided the following important updates.
Enrollment Update
DOH provided the following enrollment numbers as of January 2022 for each Medicaid managed care plan.
- Mainstream Medicaid Care: 5,274,981
- HARP: 162,170
- HIV-SNP: 15,662
- MAP: 31,516
- MLTC: 245,015
- PACE: 5,941
- Total Medicaid Managed Care: 5,736,983
Important Dates for Medicare Advantage “Only” Line of Business
Existing Medicaid Managed Care Organizations (MCOs) that want to add the Medicare Advantage only line of business must submit an application to DOH by July 1, 2022 for consideration for CMS coverage year 2024.
Existing MCOs certified under PHL Article 44 that want to add additional counties or additional Medicare types (I SNP, C SNP, non SNP) must submit a Service Area Expansion (SAE) application to DOH by November 1, 2022 for consideration for CMS coverage year 2024.
For the transactions identified above the same application is used and may be found here.
Additional important dates for the Medicare Advantage only line of business may be found here under the “Health Plan Certification in New York State” section.
For any application questions please contact the Bureau of Managed Care Certification and Surveillance at bmccsmail@health.ny.gov
The information provided above does not pertain to the Medicaid Advantage Plus (MAP) line of business or the Integrated Benefit Dual (IB Dual) premium groups under Medicaid Managed Care and HARP.
Upcoming Reporting Due Dates
DOH’s Bureau of Managed Care Fiscal Oversight reminded plans of the following reporting due dates:
- Medicaid Medical Loss Ratio (MLR) Report for State Fiscal Year *SFY) 2020-2021 is due March 25, 2022
- Medicaid Managed Care Operating Reports (MMCORs) are due April 1, 2022 and Audited Financial Statements for 2021 are also due April 1, 2022 and the March 31, 2022 Escrow Statements are due May 2, 2022
- Resubmission of Medicaid MLR Report for SFY 2019-2020 (4/1/2019 3/31/2020) will be required for plans who received retro rate adjustments since the initial submission
- Due date to be determined; plans will have 60 days to complete report
MLTC Partial Plan Nursing Home Benefit Limitation Update
The Department will initiate an additional “Batch Process” and disenrolled members will be converted to Medicaid FFS for on going coverage of their long term nursing home care, effective June 1, 2022.
DOH reminded plans of the following important dates for implementing “Batch Process”:
- March 18, 2022: Plan Survey sent to MLTCP plans to identify all potential members to be submitted for batch disenrollment
- Due Date: April 1, 2022
- March 18, 2022: Letter issued to nursing homes to identify individuals with active transition plan. These members will be removed from the disenrollment list
- Due Date: April 1, 2022
Reminder: MLTCP must continue to work with their members’ associated Nursing Homes to ensure that the completed LDSS 3559, “Residential Health Care Facility Report of Medicaid Recipient Admission/Discharge/ Readmission/Change in Status,” form or an approved local equivalent has been provided to the LDSS.
The “Batch Process” will included members who meet the following criteria:
- Designated as Long Term Nursing Home Stay (LTNHS)
- Member has been in a LTNHS for more than three months (LTNHS 3+), and
- Member has been determined by the local department of social services (LDSS) to be financially eligible for nursing home Medicaid coverage
New York Independent Assessor Implementation Date Delay
As DOH Further Delays “IA” Implementation, HCA Continues to Press for Full IA Repeal
In the latest action on implementation of the Independent Assessor (IA), the State Department of Health (DOH) announced a further delay in startup, this time to May 1. The delay is welcome news as the myriad problems and issues associated with the IA – from concept, to mechanics, to efforts to recruit nurses away from providers and direct services – continue to loom, and as HCA continues to press full-court in the Legislature and Executive for full repeal.
Also in this week’s actions, DOH announced date change for training to Wed Feb 16, but links for the registration remain the same, as do the webinar times.
HCA and a coalition of associations (LeadingAge NY, the NY Health Plan Association, the Conference of Blue Cross Blue Shield Plans, and the MLTC-PACE Coalition) continue to urge Governor and Legislature to repeal the IA. Our joint letter (LINK) is being followed up in every HCA budget meeting, as repeal of the IA is targeted among HCA’s 2022 State Budget and Legislative Priorities. Our push for IA repeal was raised by HCA in its Budget hearing testimony last week, and further raised in HCA’s Advocacy Day meetings with the Legislature, DOH and Governor’s Office.
HCA member providers and MLTC-PACE plans should similarly target IA repeal in your grassroots outreach to your individual Senators and Assembly Members. For further information or guidance on grassroots asks related to the IA, members can contact Alyssa Lovelace at alovelace@hcanys.org.
ARPA HCBS: LHCSA Directed Payment
DOH reported that Licensed Home Care Services Agency (LHCSA) submissions were due January 18, 2022. DOH is in the process of reviewing submitted attestations, spending plans and survey data. LHCSAs with missing or incomplete submission received outreach from the Department. The U.S. Centers for Medicare and Medicaid Services (CMS) provided DOH with a set of questions and DOH returned the answers promptly. CMS approval of the directed payment is pending. HCA will update the members as additional information becomes available.