GIS 12 MA/024: Centers for Medicare and Medicaid Services (CMS) approval of Partnership Plan Medicaid Section 1115 Amendment

To: Local District Commissioners, Medicaid Directors

From: Mark Kissinger, Director, Division of Long Term Care

Subject: Centers for Medicare and Medicaid Services (CMS) approval of Partnership Plan Medicaid Section 1115 Amendment

Effective Date: Immediately

The purpose of this GIS is to inform you that New York State continues to move toward a fully integrated care management system for all individuals receiving long-term care services under the Medicaid Program.

Medicaid Redesign Team Initiative #90, the transition and enrollment of certain community-based long-term care services recipients into Managed Long Term Care Plans (MLTCPs) or Care Coordination Models (CCMs), is a major component of this transformation. This initiative amends the Partnership Plan Medicaid Section 1115 Demonstration waiver to require all dualeligible individuals (persons in receipt of both Medicare and Medicaid) who are aged 21 or older and are in need of communitybased long-term care services for more than 120 days to be enrolled into partially capitated MLTCPs or CCMs.

In July 2012, the Department received verbal approval from the Centers for Medicare and Medicaid Services (CMS) to initiate mail distribution of mandatory enrollment notifications. These notifications, alerting current Personal Care Services Program recipients that they must choose a Plan to continue receiving community based long-term care services, are being rolled out in New York City. A phased approach is being used by borough and zip code and to assure that prior authorizations and Medicaid certification will remain intact through the transition. The notifications urged recipients to contact the Department's Enrollment Broker, New York Medicaid Choice, for information on joining a Plan.

On August 31, 2012, the Department received written approval from CMS and can proceed with auto-assignment of identified recipients, who have not selected a plan within 90 days of their mandatory enrollment notice, into partially capitated managed long term care plans in New York City.

The mandatory enrollment initiative will continue within the five boroughs of New York City until all eligible cases are transitioned.

In January 2013, the initiative will move to Nassau, Suffolk and Westchester counties. The Department will provide further guidance as developments warrant. Any questions concerning the transition can be directed to