Situation Report | December 14, 2020
HCA met in multiple meetings this week with Office of Health Insurance Program (OHIP) officials and Managed Long Term Care (MLTC) association colleagues on budget items and program developments.
In these discussions, HCA has offered a concept to streamline the state’s proposed process for physician panel review of high-hour MLTC cases (i.e., patients requiring over 12 hours of care per day).
Under the state’s current design, all such cases would undergo individual review by the physician panel who would be required to provide its recommendations to the MLTC. HCA has outlined an approach that could greatly simplify the review process, alleviating the volume and layers of review for patients, MLTCs, and physicians.
OHIP also conducted its monthly meeting for mainstream managed care organizations (MCOs), MLTCs, and associations with MCO or MLTC members. The discussion included MLTC and MCO program updates on enrollment, enrollment reconciliation, replacement of WMS rosters, the COVID-19 vaccination rollout, Electronic Visit Verification updates, nursing home member disenrollment, and other issues. There was an extensive discussion on OHIP’s plan for integration of behavioral health services into the new Medicaid Advantage Plan benefit package.
The discussion triggered many questions and concerns about the impact of these many moving parts on plans, network providers and patients, particularly amid the resurgence of COVID-19 infection and hospitalization rates, a nearly $32 billion dollar projected state deficit for the combined 2020 and 2021 state fiscal years, and no clear picture of state or local aid coming from the federal level.
HCA members can view the OHIP meeting slides and additional details at the links below: