Special Alert

1. ICS CLOSING MARCH 31, 2019.  As reported in January 2019 Update below, ICS MLTC plan will be closing at the end of March 2019,   Following the "unofficial"  letter of Jan. 7, 2019 announcing the closing from ICS CEO Rick Surpin, the NYS Department of Health sent all ICS members a letter dated January 25, 2019 explaining that  those members who did not contact NY Medicaid Choice to enroll in an MLTC plan by Mar. 20, 2019 would be assigned to VNS Choice MLTC plan eff. 4/1/19. ICS members who move to VNS Choice will receive the same type and amount of services ICS provided for ONE YEAR, while those who join a different plan will have only the standard 120-day continuity of care provided for in the state's  MLTC Transition policy  MLTC Policy 17.02.

New Health Home. Also, ICS members who go to VNS CHOICE may enroll in the new ICS Health Home that will be under contract with VNS to manage care for some ICS members who transfer to VNS.  Read a letter from ICS in English or Spanish about joining the ICS Health Home.   Those interested in joining the Health Home should fill out the consent form and give it to an ICS staff person, email it to ICS at MSCDocMgt@icsny.org or fax it to 718-907-1670. Here is the form in English, Spanish, Russian and Chinese.  Read the ICS Health Home brochure in English, Spanish or Russian.  For questions call ICS at  1.877.ICS.2525. See more on the ICS website. UPDATE ABOUT TRANSITION RIGHTS/CONTINUITY OF CARE in NEW MLTC PLAN.  In the January 2019 Update, we reported that ICS members who transferred to a new plan for February 2019 would NOT be entitled to transition rights, meaning that the new plan was not required to continue their same ICS plan of care for one year (if they moved  to VNS Choice) or 120 days  (if they moved to any other MLTC plan). The State Dept. of Health later revised this policy.  As long as an individual was a member of ICS in January 2019, if they transferred to a different MLTC plan effective February 2019 or later, they would have transition rights in the new plan (one year for VNS Choice and 120 days for any other plan).NEW:  If an ICS member moved to an MLTC plan other than VNS Choice effective February 2019 or later, they may still move to VNS CHOICE and receive the special  one-year transition rights/ continuity of care -- with these limitations --

1. The member must have been enrolled in ICS during January 2019.
2. The member must transfer to VNS CHOICE effective December 2019 or earlier in order to be entitled to transition rights. If they transfer to VNS Choice effective January 2020 or later, they do not have transition rights.
3. The one-year special VNS transition period begins on April 1, 2019 and ends on March 31, 2020 if the member switches to VNS Choice  effective on or after April 1, 2019. If the member  switched to VNS Choice effective March 1, 2019 (having transferred from ICS to a different MLTC plan in February 2019), then the one-year transition period will end on February 28, 2020.
4. What AMOUNT and TYPES of services must VNS Choice  continue to provide for a former ICS member who first transferred to a different MLTC plan in or after February 2019, and then moves to VNS Choice  in or before December 2019?

The individual is entitled to the same amount and types of services that ICS had provided ONLY IF the new MLTC plan to which they switched is still providing that same plan of care.  Since the new MLTC plan is required by MLTC Policy 17.02 to provide the same plan of care for 120 days, anyone who transfers to VNS Choice during the 120-day transition period is assured of receiving the same services that ICS had provided.   If the individual transfers to VNS Choice after the 120 days has lapsed, and the new MLTC plan has already reduced services, then DOH has stated that VNS CHOICE is only required to provide continuity of care at the  reduced level given by the last MLTC plan.   However, if the proposed reduction in services by the new plan has not  gone into effect, because the individual is entitled to "Aid Continuing" pending the appeal or  because she  won the appeal, then VNS Choice must continue the same services that ICS had provided.To reduce services, the plan must send the member an Initial Adverse Determination notice  that complies with MLTC Policy 16.06: Guidance on Notices Proposing to Reduce or Discontinue Personal Care Services or Consumer Directed Personal Assistance Services.  If the member requests  a Plan Appeal of  the reduction, if the Plan  denies the appeal, it must then send a Final Adverse Determination notice, which also complies with MLTC Policy 16.06.  The member may then request a Fair Hearing.  If the member requests the Plan Appeal and then, if needed, the Fair Hearing quickly within the short 10-day deadline, she will be entitled to Aid Continuing, which prohibits the plan from reducing services as proposed until the appeals are held and decided.See more about Plan Appeals and the Notices that the plan must provide of any reduction here. Download this Fact Sheet about MLTC Appeals by NYLAG EFLRP.

2. Neither the "Lock-In" Rule (described in January 2019 Update) or the Removal of Permanent Nursing Home Care from the MLTC benefit (see Oct-Nov 2018 update) have been implemented. Both changes were enacted in the 2018 NYS Budget, but the state is still awaiting CMS approval for these changes.
3. NYS Budget proposals  potentially impact access to long term care services.  Gov. Cuomo again proposed to eliminate "spousal refusal," and has proposed sweeping changes in the Consumer Directed Personal Assistance Program.  Read NYLAG Testimony about these and other Medicaid changes.  Also see testimony and budget agenda of Medicaid Matters NY and more information on the CDPAP changes here.

Lori R. Somekh NY Elder Law Group 247-67 Jericho TurnpikeBellerose, NY 11426(718) 740-3300(646) 308-9298 fax