The Future of Integrated Care In New York State

  • Presentation is also available in Portable Document Format (PDF)

September 7, 2017

  • Welcome and Introductions
    • Andrew Segal, Director, Division of Long Term Care
  • Overview of the Process
    • Erin Kate Calicchia, Bureau Director, Department of Managed Long Term Care
  • Topics:
    • Target Population
    • Covered Services
    • Care Coordination/Care Management Elements
    • Assessment and Service Planning Requirements
  • Next Steps & Questions

Welcome

Overview of the Process

Overview of the Process

  • 4 Meetings
    • Today – 9/7 – Albany
    • October 16 – NYC
    • November 16 – Albany or Rochester
    • December 8 – NYC
  • Today´s Discussion

Target Population

Target Population – Existing Integrated Programs

Fully–Integrated Duals Advantage (FIDA) Medicaid Advantage Plus (MAP) Program for All–Inclusive Care for the Elderly (PACE)
  • Has Full Medicare and Full Medicaid
  • Age 21 or older
  • Certain LTSS needs – at a minimum, needs >120 days community based care
  • Lives in NYC, Nassau, Suffolk, or Westchester counties
  • Has Full Medicare and Full Medicaid
  • Age 18 or older
  • Certain LTSS needs – at a minimum, needs >120 days community based care
  • Lives in NYC, Nassau, Suffolk, or Westchester counties or Albany, Renssellaer, Schenectady, or Montgomery
  • Has Full Medicare and Full Medicaid OR Has only Medicaid OR Has only Medicare
  • Age 55 or older
  • Certain LTSS needs – at a minimum, needs >120 days community based care
  • Lives in service area of a PACE center

Medicaid Covered Services

Medicaid Covered Services

Fully–Integrated Duals Advantage (FIDA) Medicaid Advantage Plus (MAP) Program for All–Inclusive Care for the Elderly (PACE)
  • All Medicaid State Plan Benefits are Covered by the FIDA Plan.
  • Many HCBS Waiver Services are Covered by the FIDA Plan. (TBI and NHTD Waiver Services)
  • Care team (IDT) has flexibility to cover additional items not otherwise covered by NY Medicaid.
  • Additional benefits not included in State Plan or HCBS Waivers must be covered.
  • Some Medicaid State Plan Benefits are Covered by the MAP Plan and Some Medicaid State Plan Benefits are Covered by FFS.
  • No HCBS Waiver Services are required Covered Services for the MAP Plan.
  • Care team (IDT) does not have flexibility to cover additional items not otherwise covered by NY Medicaid.
  • All Medicaid State Plan Benefits are Covered by the PACE Plan.
  • No HCBS Waiver Services are required Covered Services for the PACE Plan.
  • Care team (IDT) has flexibility to cover additional items not otherwise covered by NY Medicaid.

Existing Covered Services

The attached is a list of the services covered in one (or more) of the existing integrated programs.

Existing Covered Items and Services

Abdominal Aortic Aneurism Screening
Adult Day Health Care
AIDS Adult Day Health Care
Ambulance
Ambulatory Surgical Centers
Assertive Community Treatment (ACT)
Assisted Living Services
Assistive Technology (State Plan and Supplemental to State Plan)
Bone Mass Measurement
Breast Cancer Screening (Mammograms)
Cardiac Rehabilitation Services
Cardiovascular Disease Risk Reduction Visit (therapy for heart disease)
Cardiovascular Disease Screening and Testing
Care Management (Service Coordination)
Cervical and Vaginal Cancer Screening
Chemotherapy
Chiropractic
Colorectal Screening
Community Integration Counseling
Community Transitional Services
Comprehensive Psychiatric Emergency Programs (CPEP)
Consumer Directed Personal Assistance Services
Continuing Day Treatment
Crisis Intervention Services
Defibrillator (implantable automatic)
Dental
Depression Screening
Diabetes Monitoring (Self)
Diabetes Supplies
Diabetic Therapeutic Shoes or Inserts
Diagnostic Testing
Durable Medical Equipment (DME)
Emergency Care
Environmental Modifications
Family Planning Services
HCSS
Health/Wellness Education
Hearing Services
HIV Screening
Home Delivery and Congregate meals
Home Health
Home Infusion Bundled Services
Home Infusion Supplies + Administration + Part D Home Infusion Drugs
Home Maintenance Services
Home Visits by Medical Personnel
Immunizations
Independent Living Skills and Training
Inpatient Hospital Care (including Substance Abuse and Rehabilitation Services)
Inpatient Mental Healthcare
Inpatient Mental Health over 190–day Lifetime Limit
Intensive Psychiatric Rehabilitation Treatment Programs
Inpatient Services during a Non–covered Inpatient Stay
Kidney Disease Services (including ESRD services)
Mammograms
Medicaid Pharmacy Benefits as Allowed by State Law

Existing Covered Items and Services

Medical Nutrition Therapy
Medicare Part B Prescription Drugs
Medicare Part D Prescription Drug Benefit as Approved by CMS
Medication Therapy Management
Mobile Mental Health Treatment
Moving Assistance
Non–Emergency Transportation
Nursing Homes
Nursing Hotline
Nutrition (includes Nutritional Counseling and Educational Services)
New York State Office of Mental Health Licensed Community Residences
Obesity Screening and Therapy to Keep Weight Down
Opioid Treatment Services – Substance Abuse
Other Health Care Professional Services
Other Supportive Services the Interdisciplinary Team Determines Necessary
Outpatient Blood Services
Outpatient Hospital Services
Outpatient – Medically Supervised Withdrawal– Substance Abuse
Outpatient Mental Health
Outpatient Rehabilitation (OT, PT, Speech)
Outpatient Substance Abuse
Outpatient Surgery
Palliative Care
Pap Smear and Pelvic Exams
Partial Hospitalization (Medicaid)
Partial Hospitalization (Medicare)
PCP Office Visits
Peer–Delivered Services
Peer Mentoring
Personal Care Services
Personal Emergency Response Services (PERS)
Personalized Recovery Oriented Services (PROS)
Podiatry
Positive Behavioral Interventions and Support
Preventive Services
Private Duty Nursing
Prostate Cancer Screening
Prosthetics
Pulmonary Rehabilitation Services
Residential Addiction Services
Respiratory Care Services
Respite
Routine Physical Exam 1/year
Sexually Transmitted Infections (STIs) Screening and Counseling
Skilled Nursing Facility
Smoking and Tobacco Cessation
Social and Environmental Supports
Social Day Care
Social Day Care Transportation
Specialist Office Visits
Structured Day Program
Substance Abuse Program
Telehealth
Transportation
Urgent Care
Vision Care Services
"Welcome to Medicare" Preventive Visit
Wellness Counseling

Care Coordination/Care Management Elements

Care Coordination/Care Management Elements

Fully–Integrated Duals Advantage (FIDA) Medicaid Advantage Plus (MAP) Program for All–Inclusive Care for the Elderly (PACE)
  • Interdisciplinary Team approach to care planning.
  • Many provider types are optional participants on the IDT – at the Participant´s choice.
  • Care coordination for all Medicare/Medicaid (all Covered Services) as well as other psychosocial, and social needs.
  • Minimum contact frequency requirements.
  • In–Person contact required.
  • Sing le Care manager conducts care planning.Care coordination for Covered Services.
  • Minimum contact frequency requirements.
  • In–Person contact required.
  • Inte rdisciplinary Team approach to care planning.Mandated participation in IDT by specified disciplines.
  • Mandated process and elements for IDT care planning.
  • Care coordination for all Medicare/Medicaid (all Covered Services) as well as other psychosocial, and social needs.
  • In–Person contact required.

Assessment and Service Planning Requirements

Assessment and Service Planning Requirements

Fully–Integrated Duals Advantage (FIDA) Medicaid Advantage Plus (MAP) Program for All–Inclusive Care for the Elderly (PACE)
  • Initial assessment after enrollment, and reassessments at least every six months.
  • Reassessment upon occurrence of certain defined trigger events.
  • UAS–NY must be used as part of Assessment.
  • Service plan within first 90 days and 30 days after any reassessment.
  • Detailed list of what must be discussed during a Person–Centered Service Plan development meeting.
  • Detailed list of what must be included in a Person–Centered Service Plan.
  • No fixed form/template required for Service Plan.
  • Initial assessment prior to enrollment and reassessments at least every six months.
  • Reassessment upon occurrence of certain defined trigger events.
  • UAS–NY must be used as part of Assessment.
  • PCSP updates at least every 6 months
  • Detailed list of what must be discussed during a Person–Centered Service Plan development meeting.
  • Detailed list of what must be included in a Person–Centered Service Plan.
  • Initial assessment at time of enrollment, and reassessments at least every six months.
  • Reassessment upon occurrence of certain defined trigger events.
  • UAS–NY must be used as part of Assessment.
  • Detailed list of what must be discussed during a care planning meeting.
  • Detailed list of what must be included in a care plan.

Next Meeting Dates, Locations, and Topics

October 16, 2017 New York City
26 Federal Plaza,
6th Floor, Conference Room A/B
  1. Network Adequacy and Access
  2. Participant Rights and Protections
  3. Marketing Rules and Flexibilities
  4. Quality Standards and Measures
November 16, 2017 Albany or Rochester (TBD)
  1. Payment and Rate Considerations
  2. Outreach, Education, and Engagement of Participants and Providers
  3. MCO/Plan Requirements and Qualifications
  4. Enrollment
December 8, 2017 New York City
  1. Geographic Scope
  2. Consolidation of Existing Programs
  3. Platform for Integrating with Medicare
  4. Considerations for Transition

For More Information

FOIC BML: futureofintegratedcare@health.ny.gov

MRT 101: https://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm

MRT 90: https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/index.htm

MLTC VBP Quality Measures: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2017/docs/2017–06–02_mltc.pdf