The Future of Integrated Care in New York State

Stakeholder Session #3

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

October 16, 2017

Overview of the Process

  • The kick–off meeting for these sessions took place on July 20th in NYC
  • The last meeting was in Albany on September 7th and covered the following topics:
    • Target Population
    • Medicaid Covered Services
    • Existing Covered Services
    • Care Coordination/Care Management Elements
    • Assessment and Service Planning Requirements
  • Subsequent to today's meeting, there will be two more stakeholder sessions:
    • November 16th – Albany
    • December 8th – NYC
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Network Adequacy and Access

  • What do you think of the standards for minimum numbers of provider that we included in the draft discussion language? What should be changed and how?
  • What do you think of the rules around choice of provider we included in the draft discussion language? What should be changed and how?
  • What do you think of the rules around access to out-of-network providers we included in the draft discussion language? What should be changed and how?
  • What do you think of the time and distance travel standards for participant travel to providers we included in the draft discussion language? What should be changed and how?
  • What do you think of the appointment time standards and rules for how long one must wait to get an appointment scheduled that we included in the draft discussion language? What should be changed and how?
  • What consolidation of rules and processes would you recommend as related to network oversight and approval?
  • What do you think of the provider training and qualification requirements that we included in the draft discussion language? What should be changed and how?
  • What consolidation of rules and processes would you recommend as related to provider training and qualifications?
  • What other provider network and qualifications provisions should be included?
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Participant Rights and Protections

  • What thoughts do you have on the Rights we included in the draft discussion language? What should be changed and how?
  • What level of Grievance and Appeal integration would ideally you like to see incorporated?
  • What do you think of the requirements around participants' involvement in governance at the plan and feedback opportunities that we included in the draft discussion language? What should be changed and how?
  • What do you think of the translation and communication requirements that we included in the draft discussion language? What should be changed and how?
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Quality Standards and Measures

  • What do you think of the quality assurance requirements that we included in the draft discussion language? What should be changed and how?
  • What do you think of the quality improvement requirements that we included in the draft discussion language? What should be changed and how?
  • What reporting and quality measures should be included?
  • What existing reporting and quality measures should be eliminated?
  • What administrative efficiencies could be achieved between Medicare and Medicaid reporting requirements?
  • What consolidation or streamlining of rules and processes would you recommend?
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Marketing Rules and Flexibilities

  • What do you think of the marketing rules and protections that we included in the draft discussion language? What should be changed and how?
  • What marketing rules and protections do you want to see added?
  • What flexibilities would you like to see added?
  • What additional consolidation or streamlining of rules would you recommend?
  • What administrative processes for Marketing review and oversight would you like to see?
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Review Comment Period and Procedures

Next Steps

November 16, 2017 Albany
  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
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For More Information

Future of Integrated Care BML:

futureofintegratedcare@health.ny.gov

Future of Integrated Care website on MRT:

https://www.health.ny.gov/health_care/medicaid/redesign/future/index.htm

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