| Aetna Better Health of New York (MLTC) |
If a provider has a paid claim and submitted a signed FLSA attestation, Aetna Better Health of New York will have $0.34 applied to each service hour that was paid for dates of service between 10/13/2015 and 3/31/2016. |
4/11/2016, 4/29/2016 |
| AgeWell New York, LLC |
1. Provider Relations prepared a survey and distributed it to Home Care providers. The provider was asked to indicate the total number of hours of service provided to AgeWell New York members between October 13, 2015 and February 29, 2016. 2. AgeWell compared hours of service in the survey response to information obtained from paid claims to verify the reasonableness of the provider's response. (If the provider reported hours which exceeded the hours calculated based on paid claims by
more than 10% the provider's hours were adjusted based on the claims data). 3. A review of the reported overtime and calculation of overtime as percentage of total hours was done (there was no penalty for those that were unable to specifically identify overtime hours. 4% was established as the floor and 12% was established as the overtime percentage ceiling). 4. An applied of the overtime percentage to the hours by provider to calculate an estimated hours of overtime for the period October 13, 2015 through February
29, 2016. The plan summarized the overtime hours calculated in Step 4 and determined each provider's calculated overtime hours as a percentage of the total overtime hours. The percentages calculated were applied to the FLSA funds received by the Plan to determine the distribution to each provider |
4/6/2016 |
| AlphaCare of New York, Inc. |
AlphaCare intends to distribute FLSA funds to its contracted LHCSAs based on member attribution. Specifically, AlphaCare's lump sum will be divided by the number of member months with PCA/PCW services for the period of October 2015 – March 2016. This will provide a base rate for FLSA payment that will then be multiplied by the number of members receiving services from a particular LHCSA for each of the six months, the sum of which will equal the total FLSA payment. |
4/29/2016 |
| Catholic Managed Long Term Care, Inc. d/b/a ArchCare Senior Life and d/b/a ArchCare Community Life |
Funds were disbursed on a percentage of hours. Each provider has been sent a check in an amount that represents the same percentage of the total funds available as the percentage of hours of services rendered in relation to all hours rendered by all providers. |
4/12/2016 |
| Centers Plan for Healthy Living |
Overtime and travel hour percentages were based on FLSA survey data submitted by LHCSAs. For each organization, the following was calculated- a) the organizations historical percentage of travel and overtime hours, b) all hours authorized from claims processed for dates of service October 13, 2015 through February 26, 2016, c) the historical percentage was multiplied by all hours to calculate the "Individual FLSA Vendor Total", d) the "Individual FLSA
Vendor" total was added to the Grand Total for all FLSA Vendors, e) to determine the percentage of the overall FLSA payment to be disbursed, the "Individual Vendor Total" was divided by the Grand Total, f) the percentage of the overall FLSA payment to be disbursed was multiplied by $633,710 to determine the portion to be paid to the vendor NOTE: Any vendor with a payment less than $500 was removed and steps were recalculated |
4/1/2016 |
| CenterLight Healthcare, Inc. (Select MLTC) |
Centerlight utilized relative hours to the total hours for the period and applied the percentage to the total that CenterLight received. |
| Elant Choice Inc. d/b/a EverCare Choice |
The allocation method used was based on actual claims during the identified time period of October 13, 2015 through March 31, 2016. |
4/8/2016 |
| Elderplan, Inc. |
EP/HF analyzed all authorized hours for each LHCSA, for the six month period (10/1/2015-3/31/2016) and assigned a weighting to the total hours as a percentage of the grand total. The resulting percentage for each LHSCA is applied to the total dollar amount awarded to EP/HF by the DOH. This determines how the FLSA dollars will be allocated to each LHCSA who submitted an FLSA attestation. |
4/4/2016 |
| ElderServe Health, Inc. |
ElderServe passed on all funds as an allocation based on hours provided to ElderServe. |
4/1/2016 |
| Empire BCBS Health Plus |
Home care providers were surveyed and asked for information regarding dates of service from October 13, 2015 through March 12, 2016. Information requested included- the number of overtime hours paid at time and one half associated with out MLTC membership and the dollars associated with any travel time associated with our MLTC membership. The Plan will reimburse any/all travel expenses from the FLSA funds. The remaining funds will be allocated to each provider based on the
prorated share of total overtime hours reported by all agencies. |
by 5/27/2016 |
| Erie Niagara d/b/a Kalos Health |
Funds were distributed based on hours provided to the plan. |
4/29/2016 |
| Extended MLTC, LLC |
The allocation method was based upon hours provided by the Licensed Home Care Agency (LHCSA) to the Plan. |
3/11/2016 |
| Fallon Health Weinberg |
Funds will be disbursed based on a percentage of service provided by each agency for the 4th quarter of 2015. Each agency will submit the total number of hours of aide service provided to members during the months of October, November, and December 2015. The plan will compare the numbers reported with what is on file and will disburse the funds to each provider as a percentage of total hours. |
by 5/31/2016 |
| GuildNet |
In order to arrive at each vendor's allocation of our FLSA award we calculated each vendor's authorized hours for the period October 16, 2015 – February 29, 2016. Each vendor received the percentage that their hours were to the total hours authorized for that period. Before any funds were distributed we obtained a copy of the attestation that they are filing with NYSDOH. |
4/8/2016 |
| Hamaspik Choice, Inc. |
Hamaspik compiled a list of all the authorized service units by vendor for the applicable home care services for the dates of service between October 13, 2015 through March 31, 2016. The total amount of services authorized per vendor was then divided in accordance with the FLSA funding received to determine each vendor's amount to be allocated. Hamaspik then applied that percentage (authorized services per vendor/ total amount received) to the total dollar amount received from the state for distribution. |
4/5/2016 |
| Health Insurance Plan of Greater New York d/b/a EmblemHealth |
Funds were distributed in proportion to the percentage of total claims paid to each participating provider with dates of services that postdate the FLSA revisions. Due to claims and processing delays only claims with dates of service in the first three months of the consideration period would be representative of the proportion of claims across the entire span. All participating home care providers and Fiscal Intermediaries were included in the Claims report and only home care services
that were relevant to the recent changes to the FLSA were included in the analysis. |
4/6/2016 |
| iCircle Services of the Finger Lakes, Inc. |
iCircle pulled a listing of payments to home care service providers that provided services during the period. A percentage of the total amount paid to providers was determined. A percentage of the total paid to the provider was used to calculate the amount of the FLSA paid. |
3/29/2016 |
| Independence Care System |
Distribution of funds based on hours paid for the period October 1, 2015 through January 31, 2016 as a percentage of the total PCA/CDPAS hours paid for the same time period. The resulting percentage for each agency paid was multiplied by the State share. |
3/25/2016 |
| Integra MLTC, Inc. |
Integra allocated FLSA funding to individual providers based on a percentage of total applicable claims for dates of service in the measurement period of 10/31/2015 - 3/31/2016. |
4/7/2016 |
| MetroPlus Health Plan |
The Plan reviewed the number of hours that each home care agency billed for the period of 10/13/15 through 3/31/15. The Plan then divided the specific number of hours billed (by each contracted home care provider) by the total number of Plan hours for services. This allowed the Plan to arrive at a vendor specific percentage, which was then used to derive the amount of FLSA funding that would be distributed to each provider. |
4/6/2016 |
| Montefiore HMO, LLC |
Funding was distributed proportionally amongst contracted vendors based on Personal Care Hours authorized for the period October 2015 through March 2016. |
4/8/2016 |
| North Shore-LIJ Health Plan, Inc. (Managed Long Term Care) |
Claims data from network providers with services codes (t1016,t1020,s5125,s5126, and s5136) and dates of service between 10/1/2016 and 1/31/16 were included. Claims with hold codes were excluded. Allowed hours were calculated based on the code, s5125, s5123 or t1019 were divided by 4 to get the total hours. Service codes of s5136 or t1020 were multiplied by 13 to get the total hours. Four months of claims of ending in January 2016 to six months of claims ending on March 2016. The
actual hours were divided by 4 and multiplied by 6. To distribute the award amount the aggregate hours were divided by the total number of hours allowed to the vendor and the dollar amount to be distributed to each vendor was calculated. |
4/7/2016 |
| New York State Catholic Health Plan, Inc. (d/b/a Fidelis Care) |
Fidelis Care based the distribution of the lump sum payment on the proportionate hours of service provided to Fidelis Care members during the 3rd quarter of 2015 |
3/30/2016 |
| Prime Health Choice, LLC MLTC |
Used authorized hours from 10/1/2015 thru 3/31/2016 and allocated the State share funds to the vendors providing services based on their % of total hours. |
| Senior Health Partners |
‐ Billable codes were included in the scope of payment for attendant care, escort services, homemaker services, personal care services, including mutual personal care and per diem (live‐in) personal care and home health aide services. ‐ All providers who had rendered services were included in the population for distribution of payment, with dates of service from 10/13/2015 through payment date 2/24/16. ‐ Incurred But Not Received (IBNR)
factoring was used to account for claims that may be rendered through 3/31/16 that had not yet been received or paid. ‐ Completed units were converted to hours (per hour units billed in quarter‐hour increments and per diem services billed as one unit) ‐ Total hours were allocated by provider based on the above rationale and methodology. ‐ Final allocation was converted to a percentage by provider, which was then applied to a portion of the total funds received. ‐ Any provider who would have been
paid $10 or less was excluded (13 providers), due to the likelihood that these services were unrelated to overtime. ‐ Funds previously allocated to the providers excluded from payment in accordance with the above criteria (as noted, 13 providers) were reallocated to be distributed to the other providers in scope in accordance with the established percentages. |
4/8/2016 |
| Senior Network Health, LLC |
Dollars were allocated based on hours billed by vendors. |
4/6/2016 |
| Senior Whole Health of New York Managed Long Term Care Plan (MLTC) |
Distribution of funds to all agencies based on the percentage of members with eligible claims from the October to March time period and divided by total members with home care services. Funds to be distributed similar to a per patient per month basis. |
4/4/2016 |
| United Healthcare of NY, Inc. |
Each MLTC vendor's PCS services hours were reviewed (T1019 and T1020) the proportion of total PCS hours each vendor provided was determined. The determined proportion was used to distribute funds. |
4/8/2016, 4/25/2016, 19 still pending |
| Village Senior Services Corp. d/b/a VillageCareMAX |
The distribution methodology used was based on a combination of paid claims and authorizations. Proportion of the funds each provider received was based on actual claims submitted to the plan by provider for personal care and home care services form 10/13/15 to 12/31/15 paid by 3/9/16 and based on authorizations issued by the plan to each provider for the dates of services from 1/1/16 to 3/31/16. |
3/29/2016 |
| VNS Choice |
Payments will be based upon the percent total of hours provided to CHOICE by each Home Care Service Provider. |
| VNA Homecare Options, LLC |
VNA Homecare Options used the hours that were paid for services provided between October 2015 to March 9th, 2016 to calculate the amount that was distributed to each provider. |
3/24/2016 |
| WellCare of New York, Inc. |
The allocation paid to providers was based on authorized MLTC home care hours by provider during the October 15-March 16 period. |
4/12/2016 |
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