LeadingAge New York State Budget Review April 2017 | Page 16

Managed Long
Term Care/
Managed Care
Managed Long
Term Care/
Managed Care
SFY 2017-18 Final State Budget
Managed Long Term Care/Managed Care
While the State’s spending plan and related documents include a number of provisions impacting Managed Long
Term Care Plans, most of these will be implemented under Department of Health (DOH) administrative authority
or pursuant to a side agreement between DOH and the State Legislature. The final budget agreement rejected
proposals to require MLTC plans to use the state’s transportation manager for their members’ non-emergency
medical transportation, extended the requirement that plans pay a nursing home benchmark rate, increased
legislative access to managed care rate setting information, banned marketing and reduced quality pool payments.
The individual provisions are described below.
Legislative Provisions
MLTC Transportation Carve-Out
The final budget rejects the proposal to require MLTC plans to use the state’s Medicaid transportation managers for
their members’ non-emergency medical transportation. Instead, the budget retains statutory language advanced by
LeadingAge NY two years ago that excludes transportation services provided or arranged for enrollees of MLTC
plans from the State’s transportation vendor contracts.
Nursing Home Level of Care
The final budget rejects the proposal to raise the clinical eligibility requirements for enrollment into an MLTC plan
to permit only those who require a nursing home level of care to enroll. Nursing home level of care is defined by a
threshold score on the Universal Assessment System (UAS) tool. Fewer than one percent of current MLTC enrollees
score below the threshold.
Nursing Home Benchmark Rate Requirement
The final budget requires Medicaid managed care plans to continue to reimburse nursing homes in their networks
at the DOH-promulgated, facility-specific benchmark rate through at least Dec. 31, 2020. The benchmark rate
requirement may be continued beyond that date, but DOH may require as a condition of continuation that total
payments from Medicaid managed care plans to nursing homes must meet the value-based payment (VBP)
requirements agreed to with the Centers for Medicare and Medicaid Services (CMS). DOH may waive the VBP
requirement for purposes of extending benchmark rates if it presents a financial hardship or threatens access to care.
A companion provision to this requirement is that DOH seek authority from CMS to develop a distinct nursing
home rate cell. A provision enacted in the 2014-15 State Budget requires that plans pay the benchmark rate for
permanent residents living in out-of-network nursing homes.
LeadingAge New York/April 2017
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