State Health Department Announces HIV Special Needs Plan Enrollment to Begin

Program to provide prevention and treatment services for people living with HIV/AIDS

ALBANY, NY, April 18, 2003 - New York State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H., today announced that a comprehensive managed health care initiative for Medicaid-eligible New Yorkers who are living with HIV/AIDS is underway in New York City. The federal Centers for Medicare and Medicaid Services (CMS) has granted approval to the first contract for an HIV Special Needs Plan in New York State, clearing the way for Health First Prepaid Health Services Plan to start enrolling members on May 1.

"Special Needs Plans are a national model program that promises to provide high quality comprehensive and coordinated care to HIV-infected New Yorkers to address their unique health and medical needs," Commissioner Novello said.

In addition to the Health First contract, HIV Special Needs Plan Certificates of Authority have been issued to MetroPlus Partners in Care and Fidelis HealthierLife.

Enrollment throughout New York City is expected to expand in the next few months, following execution of contracts between these plans and the New York City Department of Health and Mental Hygiene, and contract approval by CMS. Three other health plans – Community Care Partners, New York Presbyterian System Select Health and Vida Care – are expected to receive certificates of authority later this spring.

HIV Special Needs Plans (SNPs) are an alternative to mainstream managed care plans and Medicaid fee-for-service coverage for persons with HIV/AIDS and their dependent children. The plans are a unique feature of New York State's Medicaid Managed Care 1115 Waiver granted by the Centers for Medicare and Medicaid Services. The Waiver is intended to provide protections for Medicaid's most vulnerable recipients.

The Special Needs Plans have comprehensive networks of care comprised of experienced HIV-service providers, and meet access and quality standards that address the multiple, unique and urgent needs of persons with HIV infection, including treatment adherence, HIV case management, prevention education, mental health services and nutritional counseling, among others.

The development of the SNP model involved a collaborative process led by the New York State Department of Health's AIDS Institute and Office of Managed Care working together with Designated AIDS Centers and other community health care providers, consumers and advocates. The initiative was supported by a Special Projects of National Significance grant from the federal Health Resource Services Administration.

Once HIV Special Needs Plans are underway in the five boroughs of New York City, it is anticipated that voluntary enrollment will next be available in Nassau and Suffolk counties, with possible expansion to Erie and Westchester counties later this year.

4/18/03-31 OPA