Telehealth Innovations and 2018 Quality Incentive

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1115 Waiver/Mainstream Medicaid Managed Care (MMC)
Standard/Quality	Degree of Compliance				Documentation/Citations
	Non-Compliant	Partially Compliant	Silent	Compliant
All Settings:					The mainstream Medicaid Managed Care benefit package includes the following long term services and supports (LTSS) in the home or community setting: Private Duty Nursing, Home Health Services, Personal Care Services, Consumer Directed Personal Assistance Program (CDPAP) Services, Adult Day Heath Care, AIDS Adult Day Health Care, Home-Delivered Meals (only for Enrollees who have transitioned to a MMC plan from the Long Term Home Health Care Program who received Home-Delivered Meals when in the LTHHCP). MMC Plans (aka Contractors) are required to establish and maintain an adequate and accessible network of participating providers to provide the benefit package services and meet the needs of their enrollees. Plans are required to credential such providers on a periodic basis and monitor provider performance. Plans are required to ensure, in accordance with PHL Article 44, that certain providers satisfy all applicable licensing, certification or qualification requirements under NYS law. See Medicaid Managed Care Model Contract for benefit package, network, and credentialing requirements: click here to link to Medicaid Managed Care Model Contract
1. Fully integrated into the broader community to the same degree of access as individuals not receiving Medicaid HCBS.			X		The Medicaid Managed Care program will update the Medicaid Managed Care Model Contract by 3/17/19 to require that Managed Care Plans are compliant with the pertinent requirements of the HCBS rule (see link in above cell).
-- opportunities to seek employment/ work in			x		see above response in 6F
-- engage in community life			x		See above response in cell 6F
-- control personal resources			x		See above response in cell 6F
-- receive services in the community			x		See above response in cell 6F
2. Selected by the individual among options including non-disability specific settings and an option for a private unit in a residential setting.			x		See above response in cell 6F
--the options are identified and documented in the person-centered service plan			x		See above response in cell 6F
--the options are based on the individual's needs, preferences, and for residential settings, resources available for room and board.			x		See above response in cell 6F
3. Ensure an individual's rights of privacy.			x		See above response in cell 6F
Ensure an individual's rights of dignity and respect.			x		See above response in cell 6F
Ensure an individual's rights of freedom from coercion and restraint.			x		See above response in cell 6F
4. Optimize and doesn't regiment individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with who to interact.		x			See above response in cell 6F
5. Facilitate individual choice regarding services and supports, and who provides them.		x			See above response in cell 6F
Provider-Owned or Controlled Settings:					The Medicaid Managed Care program will amend the Medicaid Managed Care Model Contract (see above link) by 3/17/19 to require any applicable provider-owned and controlled residential, and any non-residential settings, where MMC enrollees live and/or receive services, to adhere to person-centered planning guidance in accordance with 42 CFR 441.301(c)(4)(vi)(F), stating that any modification of the additional conditions, under 42 CFR 441.301(c)(4)(vi)(A) through (D), will be supported by a specific assessed need and justified in the person-centered service plan.
6. A specific place that can be owned, rented or occupied under a legally enforceable agreement by the individual receiving services.			X		See above response in 38F
The individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the jurisdiction's landlord/tenant law or equivalent.			X		See above response in 38F
7. Each individual has privacy in their sleeping or living unit:			X		See above response in 38F
-- units have entrance doors lockable by the			X		See above response in 38F
individual with only appropriate staff having keys;
-- individuals sharing units have a choice of roommates in that setting;			X		See above response in 38F
-- Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.			X		See above response in 38F
8. Individuals have the freedom and support to:
--control their own schedules and activities;			X		See above response in 38F
--have access to food at any time.			X		See above response in 38F
9. Individuals are able to have visitors of their choosing at any time.			X		See above response in 38F
10. The setting is physically accessible to the individual.			X		See above response in cell 6F
Heightened Scrutiny: (Note: if any site meets any of the below criteria then they fall under heightened scrutiny)	YES	NO	How Many?		List Heightened Scrunity Sites - Use Additional Sheets If Necessary
11. Are any settings in facilities that also provide inpatient institutional services?					We are still evaluating this at this time, however, some settings that MMC enrollees live or receive services in have been identified and are included in the respective systemic compliance chart of the division or office within DOH overseeing that setting/service.
12. Are any settings in facilities on the grounds of, or immediately adjacent to a public institution?
13. Do any of the settings serve to isolate individuals in receipt of Medicaid-funded HCBS from the broader community?