MLTC Developments: Independent Assessor Design, Contract Amendments 

Situation Report | September 8, 2020

In meetings this past week with the state Department of Health (DOH), HCA engaged in discussions on key issues for Managed Long Term Care plans and their network providers, including the “Independent Assessor” (IA) provisions of the current state budget and draft MLTC contract amendments to reflect COVID-19 emergency provisions.

HCA continued to voice great concern about the IA provisions, in particular their “one-way” design, in which all assessment decisions are to be made by the IA, without question, dual consultation nor alteration by the MLTC or provider.

HCA offered concepts for achieving bilateral engagement on assessment determinations, including initial, change-of-status, and reauthorization assessments. HCA disagrees strongly with the manner in which the IA mandate has been conceived in a manner that is at variance with core policy and clinical trends in integrated care. It introduces major conflicts with clinicans’ professional practice standards, particularly nurses under their license.

HCA appreciates DOH’s willingness to consider how our concerns might be addressed within the overall realm of the IA.

DOH also presented draft MLTC contract amendments related to the COVID emergency. See the slides here.

HCA and other participants raised numerous questions, including why DOH’s proposed overhaul does not incorporate the flexibility that Congress and the U.S. Centers for Medicare and Medicaid Services (CMS) provided to allow nurse practitioners and physician assistants to order services. DOH invited HCA to submit edits reflecting our recommendations and we welcome direct comments from members for inclusion in these recommendations.