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NYS’ Dual-Eligible Application Delayed For 30 Days

Crain’s Health Pulse�� May 2, 2012

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���������� state won’t file its application with CMS for a dual-eligible demonstration proposal for another 30 days. The delay was prompted by “numerous and extensive” comments on the plan, said the state Department of Health.

DOH said the updated proposal will include significant changes, including a managed fee-for-service element as well as alterations to the current capitated approach.

The updated proposal was scheduled to be posted today for additional public comments. DOH also said it would host two additional informational events.

The suggestion that DOH would include a managed fee-for-service option “scared a lot of people,” said an executive with a managed long-term care provider. “We thought DOH gave up on a capitated model and gave into pressure to provide LTC at any cost.”

DOH is sticking to its plan to require dual eligibles who need more than 120 days of home- and community-based care to enroll in Fully Integrated Dual Advantage plans. FIDAs would be capitated for both Medicare and Medicaid services.

But DOH has decided to pull back on phase two of the demo, which affected duals in nursing homes and those who do not need more than 120 days of services. The new approach will be a Health Home strategy. The impetus: ���������� state gets a 90% federal match rate for Health Home enrollees.

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