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New York Managed Care Program Features, as of 2018 (1 of 2)FeaturesHealth and Recovery PlansManaged Long Term CareMedicaid Advantage PlusProgram typeComprehensive MCOMLTSS only (PIHP and/or PAHP)Comprehensive MCO MLTSSStatewide or region-specific?StatewideStatewideStatewideFederal operating authority1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)Program start date10/01/201501/01/199801/01/2007Waiver expiration date (if VoluntaryExemptExemptIf the program ended in 2018, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)VoluntaryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)VoluntaryPopulations 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: Partial DualsPopulations enrolled: Children withSpecial Health Care NeedsPopulations enrolled: NativeAmerican/Alaskan NativesExempt1
FeaturesHealth and Recovery PlansManaged Long Term CareMedicaid Advantage PlusPopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptExemptExemptPopulations enrolled: Enrollment choice 30 daysperiod60 days60 daysPopulations enrolled: Enrollment broker NY Medicaid Choice/Maximusname (if applicable)NY Medicaid Choice/MaximusNY Medicaid Choice/MaximusPopulations enrolled: Notes onenrollment choice periodBenefits 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)XXBenefits covered: Partial hospitalization XBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinicsand FQHCsXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugsXXBenefits covered: Prosthetic devicesXXBenefits covered: EPSDTBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized health home2
FeaturesHealth and Recovery PlansManaged Long Term CareMedicaid Advantage PlusBenefits covered: Health home care(services in home)XXXBenefits covered: Family planningXBenefits 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 nursingXXXXXBenefits covered: ICF-IDDBenefits covered: Nursing facilityservicesBenefits covered: Hospice careXBenefits covered: Non-EmergencyMedical TransportationXXXBenefits 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.)Midwife Services, audiology, vision,occupational therapyQuality assurance and improvement:HEDIS data required?YesNoNoQuality assurance and improvement:CAHPS data required?YesNoNoQuality assurance and improvement:Accreditation required?NoNoNoPodiatryQuality assurance and improvement:Accrediting organization3
FeaturesHealth and Recovery PlansManaged Long Term CareMedicaid Advantage PlusQuality 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: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsXrequired or encouraged to pay providersfor value/quality outcomesParticipating plans: Plans in ProgramAffinity Health Plan; Capital DistrictPhysician's Health Plan; Excellus HealthPlan; Fidelis Care; HealthFirst;HealthPlus; HIP GNY; IndependentHealth Association; MetroPlus; MolinaHealthCare of New York; MVP HealthPlan; United HealthCare; YourCareHealth PlanAetna Better Health; AgeWell New York;AlphaCare; ArchCare Community Life;Centers Plan for Healthy Living;ElderPlan; ElderServe; ElderWood;Extended MLTC; Fallon HealthWeinberg; Fidelis Care; GuildNet;Hamaspik Choice; HealthAdvantage/Elant Choice; HealthPlus;iCircle Care; Independent CareSystems; Integra; Kalos Health Plan;MetroPlus; Montefiore; North Shore LIJ Health Plan; Prime Health Choice;Senior Health Partners; Senior NetworkHealth; Senior Whole Health; UnitedHealthCare; Village Care; VNAHomeCare Options; VNS Choice;WellCare AdvocateNotes: Program notesThe covered benefit of partialhospitalization only applies to enrollees21 years of age and older. CMS hasapproved HCBS within the HARPprogram under 1115(a) authority.MLTC enrollees may elect hospice care,but a hospice enrollee cannot enroll inMLTC. Some, but not all, HCBS waiverservices are covered by MLTC plans.ElderPlan; Fidelis Legacy Plan;GuildNet; HealthFirst; HealthPlusAdvantage Plus; Senior Whole Health;Village Care; VNS Choice Plus4
New York Managed Care Program Features, as of 2018 (2 of 2)FeaturesPACEMedicaid AdvantageMedicaid Managed CareProgram typeProgram of All-inclusive Care for theElderly (PACE)Comprehensive MCOComprehensive MCO MLTSSStatewide or region-specific?StatewideStatewideStatewideFederal operating authorityPACE1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)Program start 2021Waiver expiration date (if applicable)If the program ended in 2018, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)MandatoryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)MandatoryPopulations enrolled: Aged, Blind orDisabled Children or AdultsMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full DualsVoluntaryPopulations enrolled: Partial DualsVoluntaryVoluntaryPopulations enrolled: Children withSpecial Health Care NeedsPopulations enrolled: NativeAmerican/Alaskan NativesExemptExemptExempt5
FeaturesPACEMedicaid AdvantageMedicaid Managed CarePopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptExemptMandatoryPopulations enrolled: Enrollment choice N/Aperiod60 days30 daysPopulations enrolled: Enrollment broker NY 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 XXBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinicsand FQHCsXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugsXXXBenefits covered: Prosthetic devicesXXXBenefits covered: EPSDTBenefits covered: Case managementXXXXBenefits covered: SSA Section 1945authorized health home6
FeaturesPACEMedicaid AdvantageMedicaid Managed CareBenefits covered: Health home care(services in home)XXXBenefits covered: Family planningXBenefits covered: Dental services(medical/surgical)XXXBenefits covered: Dental (preventativeor corrective)XXXBenefits covered: Personal care (stateplan option)XXXXXBenefits covered: HCBS waiver services XBenefits covered: Private duty nursingXBenefits covered: ICF-IDDBenefits covered: Nursing facilityservicesXXBenefits covered: Hospice careBenefits covered: Non-EmergencyMedical TransportationXXXBenefits 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.)Podiatry, physical therapy, occupational Podiatry, outpatient rehabilitation,therapyhearing services, vision care servicesNurse midwife services, vision care, footcare servicesQuality assurance and improvement:HEDIS data required?NoNoYesQuality assurance and improvement:CAHPS data required?NoNoYesQuality assurance and improvement:Accreditation required?NoNoNoQuality assurance and improvement:Accrediting organization7
FeaturesPACEMedicaid AdvantageMedicaid Managed CareQuality assurance and improvement:EQRO contractor name (if applicable)Island Peer Review OrganizationIsland Peer Review OrganizationIsland Peer Review OrganizationPerformance incentives: Paymentbonuses/differentials to reward plansXPerformance incentives: Preferentialauto-enrollment to reward plansXPerformance incentives: Public reportscomparing plan performance on keymetricsXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomesXParticipating plans: Plans in ProgramArchCare Senior Life; Catholic Health - Affinity; Fidelis Legacy Plan; LibertyLife; CenterLight (CCM); CompleteHealth Advantage; United HealthCare;Senior Care; Eddy Senior Care; Fallon VNS Choice; WellCareHealth Weinberg; Independent Living forSeniors; PACE CNY; Total Senior CareHealthNow; HealthPlus; HIP Combined;Independent Health/Hudson Valley;WNY; MetroPlus Health Plan; MetroPlusHealth Plan Special Needs; MolinaHealthcare of New York; MVP HealthPlan; United HealthCare; VNS ChoiceSpecial Needs; WellCare; YourCareHealth Plan; Fidelis Care; HealthFirst;Affinity Health Plan; Amida Care SpecialNeeds; Capital District Physician'sHealth Plan; Crystal Run Health Plan;Excellus Health PlanNotes: Program notesCovered Benefits include non-hospicepalliative care. OB/GYN is mandatedwith a minimum age of 55 years. QualityAssurance measures would includePACE home health agency, a federallymandated internal program.The covered benefit of partialhospitalization only applies to enrollees21 years of age and older. Fidelis Carecovers emergency and non-emergencytransportation in Rockland County only. 8
Populations enrolled: Enrollment choice period : N/A . 60 days : 30 days . Populations enrolled: Enrollment broker name (if applicable) NY Medicaid Choice/Maximus . NY Medicaid Choice/Maximus : NY Medicaid Choice/Maximus . Populations enrolled: Notes on enrollment choice period : Benef
