DOH Outlines Initial MLTC Enrollment Cap Experience 

Situation Report | January 11, 2021

On Friday, the state Department of Health (DOH) presented Managed Long Term Care (MLTC) plans and member associations with feedback on the October 15, 2020 data submissions related to the MLTC enrollment caps. 

Results were shown for MLTC reporting based on each DOH-established metric for standards of reporting. The measured categories are: timeliness, completeness, internal consistency and validity. Plans are subject to a payment penalty for variation beyond a DOH-allowed range for each metric.

DOH summarized the overall track record for plan reporting based on MLTCs’ October 15, 2020 data submissions. The summary indicated the number of plans out of all 26 plans not achieving the measures. At the plans’ request, DOH said it would adopt a practice of notifying MLTCs when their reported data does not meet the DOH parameter for any of the areas. 

DOH clarified that evaluation of the (October 15) submission will not impact withhold payment reconciliations for plans in 2020-21 and that “withhold reconciliations will be pay for reporting and based on the full annual submission that is due April 15, 2021.”

When asked about the timing of 2021 enrollment cap numbers, DOH indicated that it will be reviewing the data and will inform plans if any changes are anticipated for the upcoming state fiscal year.

MLTCs also raised questions regarding county-to-county patient/member transfers. DOH indicated that it has added rows to the sub-tables to account for patient movement to different regions, allowing for consistency across tables.

DOH also noted its due date of January 15, at 11:59 p.m., for the next MLTC submissions.

Meeting slides are available here.