DOH Moves on Implementation of MLTC 2020-21 State Budget Items 

Situation Report | June 15, 2020

Over the past two weeks, officials from the state Department of Health (DOH) have offered briefings for managed long term care plans (MLTCs) and MLTC member organizations on DOH plans for implementing 2020-21 state budget items impacting MLTCs and, by consequence, home care providers as well. 

These briefings have focused on such budget cuts and reforms as: 

  • MLTC rates and reimbursement issues, including lags in past year reconciliations, quality pool payments, consequences for risk scores, and other items.
  • Imposition of an Independent Assessor to conduct the assessments for MLTC care plans and services, including change of condition and scheduled reassessments.
  • Imposition of enrollment caps and 3 percent withholds on MLTC payments.
  • MLTC encounter data requirements, withholds and penalties for late, incomplete or inaccurate submissions.
  • Threshold eligibility changes (new minimum requirements for Activities of Daily Living, or ADLs) for Consumer Directed Personal Assistance Program and Personal Care Services.
  • Care management initiatives of the state’s Medicaid Redesign Team. 

In addition, DOH, through meetings and e-mails, has notified plans and associations of the status of the carve-out of long-stay nursing home residents from MLTC as well as the Department’s draft Coordinate of Benefits Agreement for plans with Dual Eligible Special Needs Plans. 

During the briefings, HCA has probed critical questions about all of these measures, many of which continue to be unanswerable in the necessary detail for plans and providers. Since the appearance of these proposals in the state budget/MRT process, HCA has voiced our very serious concerns about the misguided nature, design and impact that many of these proposals would have on MLTCs, providers and patients. 

HCA will be continuing to press for any and all improvements or accommodations possible given the parameters of the state’s budget agreement and will be reaching out for collaborative allies across associations. 

HCA urges member MLTCs and concerned providers to weigh in directly with us as the details — and, indeed, continuing voids — of implementation are further revealed. 

Please contact any of the following HCA Policy Team members:; and/or