New York Medicaid To Integrate Care for Duals Through ACOs
Open Minds January 2, 2012
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New York Medicaid is planning to integrate financing and services for
people dually eligible for Medicare and Medicaid by partnering with
health plans and accountable care organizations (ACOs). The state seeks
to integrate care for about 700,000 dual eligible individuals. In April
2011, New York was among 15 states selected by the federal Centers for
Medicare and Medicaid Services (CMS) to participate in an integrated
care demonstration program.
The integrated care plans are part of the state’s broad Medicaid
Redesign that aims to enroll every Medicaid beneficiary into some kind
of care management organization within the next three to five years.
Medicaid-only beneficiaries (no dual eligibles) will be enrolled in
physical health managed care organizations and fee-for-service
behavioral health services will be monitored and managed by five
contracted behavioral health organizations (BHOs) acting as
administrative services organizations. After October 2013, the state
plans to replace the BHOs with a fully capitated managed care system for
both behavioral and health care services. At this point, the state may
expand the BHO scope of work to include dual eligibles. However, details
on this possible expansion of the BHO’s scope of work are not yet
available.
The recommendations for dual eligibles were released on November 1, 2011
in the “New York State Department of Health Medicaid Redesign Team
Payment Reform and Quality Measurement Work Group.” The report included
the following recommendation details:
* New York should seek a waiver from CMS that would permit New
York to assume risk for the delivery and financing of Medicare services
for dual eligible in the state.
* The state would then enter sub-capitation at-risk arrangements
with health plans and/or integrated provider organization groups,
including ACOs.
* The waiver funds could be used to implement or develop Health
Homes, ACOs, Patient-Centered Medical Homes, Clinical Integration,
Shared Savings, and/or Gainsharing.
In its January 2011 application to participate in the CMS Integrating
Care for Dual Eligible Individuals Initiative, the state provided some
indication of its plans for integration. In the application, the state
said it planned to explore the following options:
* Full risk for managing combined Medicare and Medicaid funds
* Promoting existing managed long-term care initiatives, such as
mandatory enrollment into Medicaid Advantage and Medicaid Advantage Plus
plans for duals already enrolled in a Medicare managed care plan; and
requiring all Medicare Advantage Special Needs Plans (SNPs) for dual
eligibles to integrate Medicare and Medicaid services as a condition of
contracting with the state
* Care coordination for nursing home residents through
collaboration with nursing homes and Medicare SNPs
* Developing Programs of All-Inclusive Care for the Elderly (PACE)
without walls to allow blending of Medicare and Medicaid benefits
without the requirements of the current PACE service setting so that
dual eligible could maintain access to existing health care provider
organizations in their communities
* Gain sharing demonstration that would enable the state to
provide a care management function through Medicaid for dual eligible
without assuming full risk for the Medicare benefit package
* Managed care for persons with developmental disabilities under
at-risk capitated contracts to cover the cost of all Medicare and
Medicaid covered services
New York embarked on its Medicaid redesign initiative in early 2011. The
Payment Reform and Quality Measurement Work Group recommendation noted
that ultimately, Governor Andrew Cuomo seeks to enroll “virtually every
Medicaid beneficiary into some kind of care management organization
within the next three to five years.” The New York Department of Health
recognizes that reaching full capitation where acute, behavioral health,
and long-term care services are all coordinated by a single accountable
entity will take years to develop.”
A link to the full text of “New York State Department of Health Medicaid
Redesign Team Payment Reform and Quality Measurement Work Group” may be
found in The OPEN MINDS Circle Library at
www.openminds.com/library/110111dsnyduals.htm.
A link to the full text of “New York State’s Application for the CMS
Integrating Care for Dual Eligible Individuals Initiative” may be found
in The OPEN MINDS Circle Library at
www.openminds.com/library/012811dsnymedicaiddualsapp.htm.
A link to the full text of “New York State Department of Health Medicaid
Redesign Team Behavioral Health Work Group Final Recommendations” may be
found in The OPEN MINDS Circle Library at
www.openminds.com/library/101511dsnymedicaidbhwkgrp.htm.
OPEN MINDS most recently reported on the redesign in “New York Medicaid
Managed Care Plan Opens Enrollment.” The article is available at
www.openminds.com/market-intelligence/basic/omolfree/102411mhcd3.htm.
For more information, contact: Jeffrey R. Gordon, Director, Public
Affairs Group, Office of the Commissioner, New York State Department of
Health, Corning Tower, Empire State Plaza, Albany, New York 12237;
518-474-7354; Web site: www.health.ny.gov/health_care/medicaid/redesign.
New York Medicaid To Integrate Care for Duals Through ACOs. (2012,
January 2). OPEN MINDS Weekly News Wire.