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  • How to work with LHCSA’s to have best outcomes for members as well as receive referrals.
  • How to determine best pay per hour to LHCSA’s for PCA, PCW, or HHA’s.
  • How to write a P&P (Policy and Procedure).
  • Best Practices.
  • How to work with Adult Social Day Centers.
  • How to Perform Assessments of Potential Members.
  • How To work with CHHA’s.

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  • Nurse Manager.
  • Marketing Manager.
  • Contracting.
  • Networking.
  • Provider Relations.
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history

It is helpful to understand the history of MLTC and how all this has evolved.

MLTC has been around for a number of years but recently has undergone significant changes and rethinking.

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History of MLTC

History

Medicaid spending in New York State grew from $46 billion 2007 to $53 in 2011. After taking office New York Governor Andrew Cuomo set an agenda for decreasing spending and put in place a Medicaid Redesign Team with the goal of putting instituting reforms in order to decrease NY Medicaid spending while maintaining a high level of optimal clinical services. The suggestions that came from the MRT led to changes in the way home health care particularly long term care is structured and delivered in NY State. The aim is to cut overall current spending as well as demonstrate savings in future years, improve health outcomes , and to consolidate Long Term Care (LTC) services from several different types of programs, which meant closing most existing long term care programs and shifting this care to Managed Long Term Care (MLTC) providers.

On August 31, 2012, the New York State received approval from CMS to move forward to fully implement the transition and enrollment of recipients requiring community-based long term care into Managed Long Term Care Plans or Care Coordination Models beginning in New York City (NYC). This initiative also requires all dual-eligible individuals who are aged 21 or older and are in need of community-based long term care services for more than 120 days to be enrolled into Partial MLTCPs or CCMs. Persons who are Medicaid recipients in NYC who meets the criteria above must receive those services through an MLTC plan. Individuals who are presently receiving Medicaid community-based care services will be transitioned into MLTC over time.

Letters are currently being sent out to these individuals letting them know of the requirement to choose an MLTC provider within 60 days of receiving the letter (Auto Enrolled) or a plan will be chosen for them (Auto Assigned) by Maximus (Medicaid Broker chosen by NY State).
FIDA (Fully-Integrated Dual Advantage) plan is scheduled begin in NYC in January 2014. This program will be an extension of the above and will include managing all Medicaid and Medicare related health needs of patients who meet the above criteria. Since this program is similar in many respects to the Medicare Advantage program, some Companies should be in a very good position to manage FIDA cases.
In addition by growing the, Managed Long Term Care, MLTC program, some companies will be in a perfect position to offer a greater number of members the FIDA type of programs.

In order to transition all current patients who are receiving long term home care into an MLTC, the influx of new MLTC members through the process of Auto Enrollment and Auto Assignment should continue to be very strong throughout 2013. Then, FIDA will come into play and begin in January 2014. After the initial period of transitioning members through Auto-Enroll and Auto-Assign, the market should stabilize with MLTC’s receiving the bulk of their cases from referral sources other than Maximus.
It is important to build relationships with the other types of referral sources as listed below.

It may be more profitable to hire at least one experienced in-house RN to perform the initial SAAM assessment as well as the 60 day reassessment SAAM for potential and existing members.

Critical Facts

Critical Facts

Critical Facts

Most of the new members for MLTC’s come from referral sources as opposed to potential members contacting the MLTC or signing up for the program.

Certified Home Health Agency (CHHA) – These agencies may partner with MLTC’s. CHHA provide skilled services are needed.

Licensed Home Care Services Agencies (LHCSA) – These agencies provide the PCA’s which will work in our member’s homes. Auto-enrolled and Auto-assigned cases will be able to keep their current PCA provider for at least 60 days if they choose.

Primary Care Physician (PCP) – The PCP’s remain the same under MLTC but will need to be in network for FIDA.
Adult Day Health Center (ADHC) – These allow members to participate in community based group activities.
Maximus (Auto Enrolled and Auto Assigned) – Referrals from Maximus are auto-enrolled or auto-assigned; however this will decrease or stop over time.

Other Sources (Employees, Community Outreach, Direct Marketing)

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Managed Long Term Care, MLTC

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Results will vary, and you should not use this information as a substitute for help from a licensed professional. Good luck!