Partnership Plan Waiver DD Transformation and Other Populations Amendment - April 2013

  • CMS Letter also available in portable document format (PDF)
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2–26–12
Baltimore, Maryland 21244–1850

Children and Adults Health Programs Group

April 12, 2013

Nirav R. Shah, M.D.
New York State Department of Health
Corning Tower
Governor Nelson A. Rockefeller Empire State Plaza
Albany, NY 12237

Dear Dr. Shah:

This letter is to inform you that the Centers for Medicare & Medicaid Services (CMS) is granting your request to amend New York´s Medicaid section 1115 Demonstrations, entitled "Partnership Plan" (11–W–00114/2), and "Federal–State Health Reform Partnership (F–SHRP)" (11–W–00234/2). The amendments discussed in this letter are effective from the date of this letter through the termination date of each demonstration program as follows: Partnership Plan (December 31, 2014) and F–SHRP (March 31, 2014).

This approval will allow both the Partnership Plan and F–SHRP to:

  • Expand the managed long term care (MLTC} program under the demonstration, by authorizing mandatory Medicaid managed care enrollment for individuals who have been served in the state´s Long–Term Home Health Care Program, also known as the Lombardi Program, and adding medical social services and home delivered meals to the managed care benefit so that they continue to be available to this population.
  • Allow, with appropriate beneficiary protections, mandatory enrollment into mainstream Medicaid managed care program (MMMC) for foster care children placed by the local Department of Social Services (DSS) and individuals who are eligible for Medicaid buy–in for the working disabled.
  • Apply an enhanced income standard for individuals to make it easier for individuals who need nursing home level of care to remain in the community and receive services through the MLTC Program.

In addition, the state is undertaking an effort to transform its developmental disability system using several Medicaid authorities. The Partnership Plan demonstration will be amended to complement these activities and to provide expenditure authority for certain designated state health programs, which will allow the state to receive federal matching dollars to support certain aspects of this transformation. Federal matching dollars will be available during the period of April I , 2013 through March 31, 2014 contingent upon the state meeting milestones outlined in the Special Terms and Conditions (STCs).

The CMS approval of the Partnership Plan and F–SHRP amendments is conditioned upon continued compliance with the enclosed sets of STCs defining the nature, character, and extent of anticipated federal involvement in the projects. The award is subject to our receiving your written acknowledgement of the awards and acceptance of the enclosed STCs within 30 days of the date of this letter. The waivers for the demonstrations are unchanged by this amendment, and remain in force.

Your project officer for this demonstration is Ms. Jessica Woodard. She is available to answer any questions concerning your section 1115 demonstration and this amendment. Ms. Woodard´s contact information is as follows:

  • Centers for Medicare & Medicaid Services
    Center for Medicaid and CHIP Services Mail Stop S2–01–16
    7500 Security Boulevard
    Baltimore, MD 21244–1850
    Telephone: (410) 786–9249
    Facsimile:   (410) 786–5882

Official communication regarding program matters should be sent simultaneously to Mr. Michael Melendez, Associate Regional Administrator in our New York Regional Office. Mr. Melendez´s contact information is as follows:

  • Centers for Medicare & Medicaid Services
    New York Regional Office
    Division of Medicaid and Children´s Health
    26 Federal Plaza
    New York, New York 10278

I am pleased that we were able to reach a satisfactory resolution to your request, and look forward to working with you and your staff as you seek to redesign the New York Medicaid program. If you have questions regarding the terms of this approval, please contact Ms. Jennifer Ryan, Acting Director, Children and Adults Health Programs Group at (410) 786–3393.


Cindy Mann


cc: Jennifer Ryan, CMS Diane Gerrits, CMS
      Michael Melendez, ARA, New York Regional Office
      Jason Helgerson, Deputy Commissioner, New York Department of Health
      Vallencia Lloyd, Office of Health Insurance Programs, New York Department of Health
      Courtney Burke, Office of People with Developmental Disabilities, New York Department of Health