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New York Managed Care Program Features, as of 2020 (1 of 2)FeaturesManaged Long Term CareMedicaid Advantage PlusMedicaid AdvantageProgram typeMLTSS only (PIHP and/or PAHP)Comprehensive MCO MLTSSComprehensive MCOStatewide or region-specific?StatewideStatewideStatewideFederal operating authority1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)Program start date01/01/199801/01/200710/01/2006Waiver expiration date (if VoluntaryVoluntaryPopulations enrolled: NativeAmerican/Alaskan NativesExemptExemptExemptPopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptExemptExemptIf the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)Populations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)Populations enrolled: Aged, Blind orDisabled Children or AdultsPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)Populations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full DualsPopulations enrolled: Children withSpecial Health Care Needs379
FeaturesManaged Long Term CareMedicaid Advantage PlusMedicaid AdvantagePopulations enrolled: Enrollment choice 60 daysperiod60 days60 daysPopulations enrolled: Enrollment broker NY Medicaid Choice/Maximusname (if applicable)NY Medicaid Choice/MaximusNY Medicaid Choice/MaximusBenefits covered: Inpatient hospitalphysical healthXXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Outpatient hospitalphysical healthXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXPopulations enrolled: Notes onenrollment choice periodBenefits covered: Partial hospitalizationBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXXXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugsXXBenefits covered: Prosthetic devicesXXXXXBenefits covered: Home health services X(services in home)XXBenefits covered: Rural health clinicsand FQHCsBenefits covered: Clinic servicesBenefits covered: EPSDTBenefits covered: Case managementBenefits covered: SSA Section 1945authorized Health HomeBenefits covered: Family planning380
FeaturesManaged Long Term CareMedicaid Advantage PlusMedicaid AdvantageBenefits covered: Dental services(medical/surgical)XXXBenefits covered: Dental (preventativeor corrective)XXXBenefits covered: Personal care (stateplan option)XXXBenefits covered: HCBS waiver services XXBenefits covered: Private duty nursingXXBenefits covered: Nursing facilityservicesXXBenefits covered: Hospice careXBenefits covered: Non-EmergencyMedical TransportationXXBenefits covered: ICF-IDDXXPodiatryPodiatry, outpatient rehabilitation,hearing services, and vision careservices.Benefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Quality assurance and improvement:HEDIS data required?NoNoNoQuality assurance and improvement:CAHPS data required?NoNoNoQuality assurance and improvement:Accreditation required?NoNoNoIsland Peer Review OrganizationIsland Peer Review OrganizationIsland Peer Review OrganizationQuality assurance and improvement:Accrediting organizationQuality assurance and improvement:EQRO contractor name (if applicable)381
FeaturesManaged Long Term CarePerformance incentives: Paymentbonuses/differentials to reward plansXPerformance incentives: Preferentialauto-enrollment to reward plansXPerformance incentives: Public reportscomparing plan performance on keymetricsXMedicaid Advantage PlusMedicaid AdvantagePerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomesParticipating plans: Plans in ProgramAetna Better Health; Agewell New York;Archcare Community Life; Centers Planfor Healthy Living; Elderplan;Elderserve; Elderwood; ExtendedMLTC; Fallon Health Weinberg; FidelisCare; Hamaspik Choice MLTC; IntegraMLTC; Icircle Care MLTC; HealthAdvantage/Elant Choice; HealthPlus;Kalos Health Plan; MetroPlus;Montefiore HMO MLTC; Prime HealthChoice; Senior Health Partners; SeniorNetwork Health; Senior Whole Health;Village Care; VNA Homecare Options;VNS ChoiceAgewell New York; Centers Plan;Fidelis Legacy Plan; United HealthCare;Elderplan; Elderserve; Fidelis LegacyWellCarePlan; HealthFirst; HealthPlus AdvantagePlus; Senior Whole Health; VillageCare; VNS Choice PlusNotes: Program notesMLTC enrollees may elect hospice care,but a hospice enrollee cannot enroll inMLTC. Some, but not all, HCBS waiverservices are covered by MLTC plans.Quality Incentive is a plan performanceincentive. It is comprised of measures ofsatisfaction, quality, compliance andefficiency which equate to points. Afinancial incentive payment is made toplans achieving a score at or above thethresholds.Quality Incentive is a plan performanceincentive. It is comprised of measures ofsatisfaction, quality, compliance andefficiency which equate to points. Afinancial incentive payment is made toplans achieving a score at or above thethresholds.382
New York Managed Care Program Features, as of 2020 (2 of 2)FeaturesMedicaid Managed CareHealth and Recovery PlansPACEProgram typeComprehensive MCO MLTSSComprehensive MCOProgram of All-inclusive Care for theElderly (PACE)Statewide or region-specific?StatewideStatewideStatewideFederal operating authority1115(a) (Medicaid demonstrationwaivers),1937 Alt Benefit Plan,1945Health Homes1115(a) (Medicaid demonstrationwaivers),1945 Health HomesPACEProgram start date10/01/199710/01/201501/01/2001Waiver expiration date (if applicable)03/31/202203/31/2022Populations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)MandatoryVoluntaryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)MandatoryVoluntaryPopulations enrolled: Aged, Blind orDisabled Children or AdultsMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryIf the program ended in 2020, indicatethe end datePopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full DualsVoluntaryPopulations enrolled: Children withSpecial Health Care NeedsMandatoryPopulations enrolled: NativeAmerican/Alaskan NativesExemptExemptExempt383
FeaturesMedicaid Managed CareHealth and Recovery PlansPACEPopulations enrolled: Foster Care andAdoption Assistance ChildrenMandatoryExemptExemptPopulations enrolled: Enrollment choice 30 daysperiod30 daysN/APopulations enrolled: Enrollment broker NYS Medicaid Choice/Maximusname (if applicable)NY Medicaid Choice/MaximusNY Medicaid Choice/MaximusPopulations enrolled: Notes onenrollment choice periodBenefits covered: Inpatient hospitalphysical healthXXXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: Outpatient hospitalphysical healthXXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: Partial hospitalization XXXBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinicsand FQHCsXXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugsXXXBenefits covered: Prosthetic devicesXXXBenefits covered: EPSDTXBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized Health HomeXX384
FeaturesMedicaid Managed CareHealth and Recovery PlansPACEBenefits covered: Home health services X(services in home)XXBenefits covered: Family planningXXBenefits covered: Dental services(medical/surgical)XXXBenefits covered: Dental (preventativeor corrective)XXXBenefits covered: Personal care (stateplan option)XXXBenefits covered: HCBS waiver services XXXBenefits covered: Private duty nursingXXXBenefits covered: ICF-IDDBenefits covered: Nursing facilityservicesXBenefits covered: Hospice careXXXBenefits covered: Non-EmergencyMedical TransportationXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitXXBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Nurse midwife services, audiology,vision care, foot care services,occupational therapy, physical therapy,and speech therapy.Nurse midwife services, audiology,vision care, foot care services,occupational therapy, physical therapy,and speech therapy.Podiatry, physical therapy, andoccupational therapy.Quality assurance and improvement:HEDIS data required?YesYesNoQuality assurance and improvement:CAHPS data required?YesYesNoQuality assurance and improvement:Accreditation required?NoNoNo385
FeaturesMedicaid Managed CareHealth and Recovery PlansPACEQuality assurance and improvement:EQRO contractor name (if applicable)Island peer Review OrganizationIsland Peer Review OrganizationIsland Peer Review OrganizationPerformance incentives: Paymentbonuses/differentials to reward plansXXPerformance incentives: Preferentialauto-enrollment to reward plansXXPerformance incentives: Public reportscomparing plan performance on keymetricsXXPerformance incentives: MCOs/PHPsXrequired or encouraged to pay providersfor value/quality outcomesXParticipating plans: Plans in ProgramAffinity Health Plan; Capital DistrictPhysician's Health Plan; Excellus;Fidelis Care; HealthFirst; HealthPlus;HIP GNY; Independent HealthAssociation; MetroPlus; MolinaHealthcare of New York, Inc; MVPHealth Plan; United HealthcareQuality assurance and improvement:Accrediting organizationPerformance incentives: Withholds tiedto performance metricsIndependent Health/Hudson Valley &WNY; MetroPlus Health Plan; MetroPlusHealth Plan Special Needs; MolinaHealthcare of New York, Inc.; MVPHealth Plan; United Healthcare; VNSChoice Special Needs; Affinity HealthPlan; Amidacare Special Needs; CapitalDistrict Physician's Health Plan;Excellus; Fidelis Care; Health First;Health Now; HealthPlus; HIP CombinedArchcare Senior Life; Catholic HealthLife; Centerlight (CCM); CompleteSenior Care; Eddy Senior Care; FallonHealth Weinberg; Independent Living forSeniors; PACE CNY; Total Senior Care386
FeaturesMedicaid Managed CareHealth and Recovery PlansPACENotes: Program notesThe covered benefit partialhospitalization only applies to enrollees21 years of age and older. Fidelis Carecovers emergency and non - emergencytransportation in Rockland County only.MMC includes children’s HCBSauthorized under the State’s 1915cChildren’s waiver and 1115 MRTWaiver.The covered benefit partialhospitalization only applies to enrollees21 years of age and older. CMS hasapproved HCBS within the HARPprogram under 1115(a) authority.Enrollment includes both full and partialdually eligibles, as well as qualified andspecified low income (QMB/SLMB)Medicare Support programs, must be 55years of age or older. PACE has acomprehensive mandate to cover allservices deemed necessary by IDT.Covered Benefits include non-hospicepalliative care. OG/GYN is mandatedwith a minimum age of 55 years. QualityIncentive is a plan performanceincentive. It is comprised of measures ofsatisfaction, quality, compliance andefficiency which equate to points. Afinancial incentive payment is made toplans achieving a score at or above thethresholds.387
Archcare Community Life; Centers Plan for Healthy Living; Elderplan; Elderserve; Elderwood; Extended MLTC; Fallon Health Weinberg; Fidelis . Senior Care; Eddy Senior Care; Fallon Health Weinberg; Independent Living for Seniors; PACE CNY; Total Senior Care . 387 Features .
