4403f.(11b.) Hamaspik Choice a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from Extended MLTC. A Partial Capitation Plan

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Hamaspik Choice (Hamaspik), a Partial Capitation MLTC plan in New York State, acquired the Extended MLTC, LLC (Extended), Partial Capitation membership effective August 1, 2023, and agreed to offer 120 days continuity of care to Extended members.

Of the 4,603 members that transferred from Extended to Hamaspik, a random sample of 1,000 members were selected. A listing of the personal care hours each member was receiving prior to transition, as well as after the transition upon reassessment, along with the changes in personal care hours, if any, was requested. Additionally, for any instance of a decrease in hours an explanation for the decrease with supporting documentation was requested.

Service Authorization changes for Extended Enrollees who transferred to Hamaspik Choice
No Change	840
Hours remained Same	840
Increase	62
Hours Increased after Transition	62
Decrease	98
Change In Assessment/Health Status	64
Member Requested Decrease Due to Informal Support	6
Member in SNF/Rehab/Hospital	8
Member Expired	13
Member No Longer Enrolled	7
Grand Total	1000

The summary of the status of service authorizations for the 1,000 randomly selected Extended enrollees who transferred to Hamaspik one year following expiration of the continuity of care period is presented below. Overall, members averaged a decrease of 0.2 hours. Members who had a change in their plan of care, on average, saw a decrease of 1.3 hours.

Additionally, from the sample of 1,000, 50 members were selected for a case review. The case review was performed to validate the accuracy of the information provided by the Plan on Service Authorization changes. The information and/or data received consisted of a Plan of Care from Extended prior to the transition, Plan of Care from Hamaspik after reassessment, Care Management notes, and any service request determination or plan action notices sent for the time frame specified. Additionally, after the initial request, the Plan was asked to submit supplementary information for specific enrollees to further clarify potential issues. Upon review of the supplementary information, the accuracy of the submitted data was able to be verified.