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News on MLTC & FIDA -- and Last Chance to Donate for 2016!
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The NYS Dept of Health (DOH) made this change in response to complaints that the in-home conflict-free assessment conducted by New York Medicaid Choice, a state contractor, had to be completed a second time if the consumer could not secure enrollment in an MLTC plan before it expired after 60 days. Such delays are common because of the need to schedule enrollment visits by MLTC plans and the need to enroll by the 18th of the month to secure enrollment for the 1st of the following month. Click here to see the DOH directive and more information. See our Fact Sheet for tips on these assessments. |
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The Centerlight MLTC plan, called "Centerlight Select," which had 5,099 members in November 2016, is closing its doors as of February 1, 2017. All of its members will be transitioned to the Centers Plan for Healthy Living MLTC Plan, unless they select and enroll in a different plan before January 11, 2017. Centerlight will continue to operate its PACE plan. For advocacy tips on ensuring continuity of care for consumers faced with this transition and more information, see here and this article on appeal rights.
Centerlight MLTC members will be transitioned solely to Centers Plan's MLTC plan, not its Medicare Advantage or FIDA plans, unless the consumer specifically chooses those plans. This means the consumer keeps their preferred type of Medicare coverage (Original Medicare or Medicare Advantage) separate from the MLTC plan. See Caregivers' Fact Sheet on FIDA (English) (Spanish version) (Russian version) (Chinese version) (Korean version)
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In late November, DOH Issued two important policy directives on MLTC:
- MLTC Policy 16.07: Guidance on Task–based Assessment Tools for Personal Care Services and Consumer Directed Personal Assistance Services - clarifies that Task-based assessment tools cannot be used to establish inflexible or “one size fits all” limits on the amount of time that may be authorized. Individualized assessment must take into account frequency and span of time during which needs arise, and must afford sufficient time for safety monitoring, supervision or cognitive prompting to assure the safe completion of tasks.
- MLTC Policy 16.06: Guidance on Notices Proposing to Reduce or Discontinue Personal Care Services or Consumer Directed Personal Assistance Services - clarifies requirements for plans to specify a change in medical condition or other circumstances, or a material mistake made in a previous assessment that now justifies a reduction in hours. Gives helpful examples to prevent plans from simply reciting boilerplate language alleging a change or mistake. See more here.
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The State Dept. of Health announced on December 15th that it would provide additional funding to MLTC's designated to ensure that all home care workers receive the increase in minimum wage guaranteed by recent amendments to state law, starting in New York City in 2017. Thanks to advocacy by the Consumer Directed Personal Assistance Association (CDPAANYS) and other organizations, the December 15th announcement clarified that the extra funding will apply to consumer-directed personal assistants as well as to traditional personal care aides. See more here.
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The FIDA Demo continues in a limited area confined to New York City and Nassau County. Expansion to Westchester and Suffolk Counties was delayed but is slated for some time in 2017. When FIDA began, all MLTC members received notices that they would be "passively" (automatically) enrolled in FIDA unless they " opted out" and chose to remain in MLTC. Most MLTC members did opt out, preferring to keep their Medicare coverage separate from their MLTC plan. By opting out, they receive home care, dental, podiatry, adult day care, vision and some other Medicaid services from their MLTC plan, and their Medicare services separately from either their chosen Medicare Advantage plan or Original Medicare with a separate Part D plan and optional Medigap policy.
FIDA, in contrast, combines a Medicare Advantage plan with an MLTC and Medicaid plan all in one plan, to provide all Medicare and Medicaid services. Consumers have the convenience of one insurance card and one plan for all services, but must use only providers within the FIDA plan's network for all Medicare and Medicaid services. The consumer's decision whether to join FIDA is based on their own individual circumstances, such as whether their preferred physicians and other providers are in the plan's network and whether their prescriptions are covered by the plan's formulary.
In 2016, the State Dept. of Health made FIDA a purely voluntary program, with no more "passive" enrollment and no need to affirmatively "opt out" to stay in MLTC with separate Medicare coverage. Among this and other changes in FIDA, DOH has embarked on a marketing campaign to encourage enrollment. Read about it here. More information is now available online about FIDA. See summary of 2016 changes in FIDA here.
Some consumers may be confused by the marketing messages from the State and their MLTC plans. Even if they opted out of FIDA, they may be contacted by their MLTC plan to encourage them to switch to the same company's FIDA plan, and they may receive letters from the State like this special mailing, encouraging FIDA enrollment.
For individual counseling on whether to choose FIDA, consumers may call the ICAN Ombudsprogram (Independent Consumer Advocacy Network)(TEL 844-614-8800) or New York Medicaid Choice (1-888-401-6582), the State's enrollment broker for FIDA.
For more info see:
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6. NYLAG Evelyn Frank Legal Resources Program Wishes You a Happy New Year! Please Help Us Meet our Challenge Grant with Your Donation!
Our grants only partly support the work we do for Holocaust survivors and other seniors and people with chronic disabilities. We thank those who have already generously given, and ask for your support to help us meet the crushing demand for our services.
Please help us meet a generous challenge grant from FJC Foundation of Donor-Advised Funds. Please click here to donate and please select the Evelyn Frank program in the “Select a Unit” dropdown box,
- or please make checks payable to "NYLAG" and mail to: NYLAG, 7 Hanover Square, 18th floor, NY NY 10004 ATTENTION: EFLRP CAMPAIGN
Thank you for your support and best wishes for happy holidays and a healthy new year!
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