4403f. (11b.) Empire BCBS HealthPlus (effective 1/1/2024 known as Anthem HP), a Partial Capitation plan, Post Acquisition Reporting of Member Service Authorizations from Integra MLTC, Inc. a Partial Capitation Plan

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Anthem HP, a Partial Capitation MLTC plan in New York State, acquired the Integra MLTC Inc., Partial Capitation membership effective December 1, 2022, and agreed to offer 120 days continuity of care to Integra members. Of the 36,295 members that transferred from Integra to Anthem HP, a standard size random sample of 50 members were selected for a case review. The information and/or data received consisted of a Plan of Care from Integra prior to the transition, Plan of Care from Anthem HealthPlus, 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.

The summary of the status of service authorizations for Integra enrollees who transferred to Anthem HP one year following expiration of the continuity of care period is presented below. Overall, members averaged an increase of 0.8 hours. Members who had a change in their plan of care, on average, saw an increase of 9.5 hours.

Service Authorization changes for Integra Enrollees who transferred to Anthem HP
No Change	46
Hours remained Same	46
Increase	3
Hours Increased after Transition	3
Decrease	1
Member had Medicare Rehab Stay	1
Grand Total	50