Dual Eligible Initiative

February 16, 2012

Care Management for All

  • New York State is moving toward providing integrated services and care management for all Medicaid recipients.
  • For dual eligibles must include both Medicare and Medicaid services.
  • Will initiate this movement this summer with mandatory enrollment of those who need care management most - those in need of long term community-based services into MLTCPs and CCMs.

Next Steps

  • Department currently has a Dual Integration Planning Contract with CMS to develop a demonstration program.
  • Application due to CMS in April 2012.
  • If approved, will begin to integrate care and provide care management for all duals in phases, starting with those in receipt of community based long term care services.
  • Intend to include other populations over time.

Proposed Dual Demonstration Outline

  • Beginning January 1, 2014, dual eligibles in Phase 1 and 2 (NYC and Nassau, Suffolk and Westchester) of the Managed Long Term Care/CCM rollout would be passively enrolled in a Medicare plan - preferably one that is linked to the long term care plan. (Other states will begin their demonstration in January 2013.)
  • CMS and DOH will need to approve plans to participate in the demonstration.
  • Many of the inconsistent rules between Medicare and Medicaid will be aligned through a three-way agreement (e.g. enrollment/disenrollment/ grievance and appeals).
  • Enrollment will be phased-in by service type by borough by zip code in batches. People will be given 60 days to choose a plan according to the following schedule:
  • Individuals who are passively enrolled will have the ability to opt out of the Medicare plan if they choose.
  • The plans participating in the demonstration will be required to cover a comprehensive benefit package that includes:
    • Medicare services, including Part D
    • Medicaid services, including all long term care
  • Behavioral health services could be provided through the plan or contracted Behavioral Health Organization.

Key Dates in New York's CMS Demonstration Medicare Timeline (Draft)

  • November 2012 Notice of Intent to apply for Medicare plan to CMS.
  • February 2013 - Medicare application (including network due to CMS).
  • June 2013 - Submit proposed benefit package.
  • June-September 2013 - Plan selection complete.
  • August-September 2013- Readiness reviews and plans finalize policies and procedures.
  • September 20 2013 - Three way contracts.
  • October 1, 2013 - Beneficiary notification with opt out.
  • January 1, 2014 - Demonstration start.