The Impact of Managed Long Term
Care for Residents and Service
Coordinators
New York State Association of Resident Service Coordinators
June 5, 2014
Embassy Suites
6646 Old Collamer Rd
E. Syracuse NY 10357
Ken Harris
Senior Policy Analyst
LeadingAge New York
Agenda
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HUD Update
Federal and State Initiatives
New Landscape for New York Seniors
Impact on Senior Housing
MLTC
FIDA
 DSRIP
 Senior Supportive Housing Program
 What’s Next?
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Acronyms
 THUD
 MLTC
 MAP
 FIDA
 BIP
 DSRIP
 SSHSP
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The Future of Senior Housing
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HUD Update
New HUD Multifamily Program Administration Office (PAO)
Five Goals:
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Producing and preserving affordable housing for those most
in need and in locations where it’s most needed;
Preserving affordable housing by improving risk management
practices and expanding or enhancing preservation programs;
Strategically controlling program costs by taking innovative
approaches to managing our portfolio;
Making the business case for increased investments in our
programs to provide the tools we need to do our work; and
Continuing to provide quality customer service while
transforming the way we work to 21st century best practices.
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HUD 2014 Priorities
On March 5, 2014, Benjamin Metcalf, Deputy Assistant Secretary for
Multifamily Housing Programs, issued 25 priorities for 2014:
Selected few with senior housing impact:
Inclusionary Requirements: Review the implications of Thompson
v. HUD with respect to implementing Multifamily Housing programs.
Thompson v. HUD found that HUD violated the Fair Housing Act of
1968 by unfairly concentrating African-American public housing
residents in the most impoverished, segregated areas of the city of
Baltimore, MD.
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HUD 2014 Priorities
RAD: Lift the RAD cap from 60,000 units of public housing and Section
8 Mod Rehab, and extend the demonstration timeframe for Rent
Supplement and RAP. Work to encourage the use of RAD to achieve
the neighborhood revitalization goals of the new Promise Zone
Program.
Issue the 4350.1 Handbook: Provide clear and current guidelines to
industry partners and field staff to improve risk management practices,
enhance portfolio oversight and ensure the availability of high quality
assisted and insured housing opportunities.
202 Demonstration NOFA: The FY 2014 Omnibus Appropriations bill
authorizes sweeping of residual receipts and using other available
Section 202 funds to fund demonstration programs testing housing with
services model to avoid or delay nursing home services. The bill also
made changes to Section 202 Statute to eliminate capital advance
requirements and authorize operating assistance-only grants.
Multifamily will utilize these new authorities to issue a 202
Demonstration NOFA.
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HUD 2014 Priorities
Enhance Service Coordinator Program: Promote an outcomes
oriented approach to services coordination for our elderly residents.
This may include standardizing the work that service coordinators
perform, mandating best practices and facilitating training on best
practices, different tracking of outcomes by updating the semi-annual
performance report, and by promoting the use of service
coordinators in certain PRAC properties.
HUD Section 202 22015 THUD Budget
Administration (HUD): $440 million
Senate: $440 million
U.S. House of Representatives Appropriations Committee: $420
million. $20 million less eliminates the Rental Assistance
Demonstration program.
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New “Section 202” Program
Elderly Project Rental Assistance (Section 202 PRA Demo)
New Model for Section 202 Program:
 Allows properties to set-aside housing for elderly population that
is older, poorer, and frailer than those who normally access
housing subsidized through LIHTC and/or HOME.
 Strong emphasis on Service Coordination linked to communitybased services.
 Conduct rigorous evaluation of the impact of 202 housing plus
service model and demonstrate outcome.
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New “Section 202” Program
Elderly Project Rental Assistance (Section 202 PRA Demo)
Notice of Funding Availability (NOFA); Summer 2014
Will require that applicants have an agreement for the provision of
services and the summary of the bill suggests that the new Section
202 program demonstration will be operated in accordance with and
determined by state healthcare priorities.
HUD intends to provide $4 million for a research assessment of the
new demonstration program.
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New “Section 202” Program
Elderly Project Rental Assistance (Section 202 PRA Demo)
Evidence-based housing with services models can significantly
reduce Medicare expenditures on hospitalization and Emergency
Room visits for people who:
 Have chronic conditions
 Need support with Activities of Daily Living and/or Instrumental
Activities of Daily Living (IADL)
 Eligible for Home and Community Based Services
Housing with service model can reduce these high health costs
by allowing residents to age in place and facilitating the provision of
supportive services.
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Federal & State Priorities
Priorities & Goals & Funding: Federal and State Senior Housing
The Good News and The Bad News
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Reduce Medicaid costs
Involve housing and health agencies (F&S)
Prevent institutionalizations
Reduce hospitalizations (Medicare)
Increased health care and service coordination
Higher health needs for senior housing residents
Reduced (eliminated) funding for senior housing and service
coordination
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Medicaid Redesign
MRT #90 Mandatory Enrollment in MLTC:
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Approval was granted by the Centers for Medicare and Medicaid
Services (CMS) to fully implement the transition and enrollment of
individuals requiring community-based long term care into Managed
Long Term Care (MLTC) Plans or Care Coordination Models.
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Expands MLTC for Medicaid members who are also eligible for Medicare
(dual eligibles) and currently receiving community-based long term care
services.
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Benefit package includes home care, personal care, social supports, and
transportation services.
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The costs of skilled nursing facility services are included in the capitation
payment, providing a financial incentive for the Plans to keep their
members healthy and living in the community.
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Managed Long Term Care (MLTC)
Mandatory Population:
 Dual eligible, aged 21 and over, receiving community-based long
term care services for over 120 days.
 Duals between 18 and 20 remain voluntary.
MLTC initially excluded the following:
 Nursing Home Transition and Diversion waiver participants;
 Traumatic Brain Injury waiver participants;
 Nursing Home residents
 Assisted Living Programs; and
 Dual eligible that do not require community-based long term care
services.
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Managed Long Term Care
Enrollees have a choice of three MLTC Plans
• Partially Cap (Medicaid)
Benefit package is long term care and ancillary services including
home care and unlimited nursing home care.
• Program of All-Inclusive Care for the Elderly (PACE)
(Medicare and Medicaid)
Benefit package includes all medically necessary services – primary,
acute, and long term care.
• Medicaid Advantage Plus (MAP) (Medicare and Medicaid
Benefit package includes primary, acute, and long term care services
(excludes specialized mental health services).
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MLTC Enrollment
 Phase 1: the five counties of New York City: New York,
Kings, Bronx, Queens, and Richmond counties.
 Phase II: Nassau, Suffolk, and Westchester Counties.
 Phase III: Rockland and Orange Counties.
 Phase IV: Albany, Erie, Onondaga, and Monroe Counties.
 Phase V: Other counties with capacity.
 Phase VI: Previously excluded dual eligible groups
contingent upon development of appropriate programs.
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MLTC Enrollment
 In December 2013, enrollment started in Albany, Erie,
Onondaga, and Monroe counties.
 As of March 1, 2014, enrollment in these counties include:
 Albany = 199
 Onondaga = 691
 Monroe = 832
 Erie = 476
 NYSDOH did not seeing any major concerns with access in these
counties. There were some coding problems with some LTHHCP
cases which were resolved.
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MLTC Enrollment
Preparations are underway for next phase of the transition, as Plan
capacity is established, the Department proposes to roll out
Mandatory Managed Long Term Care in the remaining counties as
follows:
• May: Rensselaer, Cayuga, Herkimer and Oneida
• June: Greene, Schenectady, Washington and Saratoga
• July: Dutchess, Montgomery, Broome, Fulton, Madison,
Schoharie and Oswego
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MLTC Enrollment
• August: Warren, Delaware, Niagara, Otsego and Chenango
• September: Essex, Clinton, Franklin and Hamilton
• October: Jefferson, Lewis, St. Lawrence, Steuben, Chautauqua,
Cattaraugus and Alleghany
• November: Yates, Seneca, Schuyler, Tioga, Cortland and
Chemung
• December: Genesee, Livingston, Ontario, Orleans, Tompkins,
Wayne and Wyoming
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MLTC
Anticipated start dates of the previously excluded dual eligible
groups begin enrollment upon development of appropriate programs:
• Nursing Home Transition and Diversion waiver participants in
2015;
• Traumatic Brain Injury waiver participants in 2015;
• Nursing Home residents, new to custodial status only, in
September 2014;
• Assisted Living Program participants date to be determined; and
• Dual eligibles that do not require community-based long term
case services date to be determined.
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MLTC
Participant Ombudsman (PO):
 The PO will act as a resource and advocate for Participants and
their families/caregivers who transition to MLTC Plans.
 The PO will be an independent, conflict-free entity that provides
Participants in MLTC, FIDA, and Mainstream free assistance in
accessing care, understanding and exercising rights and
responsibilities, and appealing adverse decisions.
 The RFA was released on February 28, 2014.
 Application were due April 11, 2014, and are under review.
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MLTC
What’s The Impact?
Three populations in senior housing:
1. Not on Medicaid
2. Qualify for Medicaid. Not receiving LTC services
3. On Medicaid – receiving LTC services for 120+ days
• LTC Medicaid residents need to choose a plan
• MLTC residents will have care coordination.
• Residents may lose, change, or add LTC services
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MLTC and Senior Housing
What’s The Impact to Service Coordinators?
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Understand the new senior housing:
MLTC will strive to reduce costs
Service coordinators need to work with MLTCs
Determine “job roles” of SC and MLTC
Some nursing homes may close….
Higher health needs of residents in senior housing
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FIDA
Fully Integrated Dual Advantage (FIDA)
 A key component of “care management for all” is the Fully
Integrated Dual Advantage (FIDA) demonstration project, a
partnership between CMS and NYSDOH.
 Through this effort certain dual eligible individuals residing in the
FIDA demonstration region will be enrolled into fully-integrated
managed care products.
 The Memorandum of Understanding between CMS and NYSDOH
was signed on August 26, 2013.
 Demonstration period is from October 2014 through December
2017.
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FIDA
FIDA Eligible Populations:
 Age 21 or older;
 Entitled to benefits under Medicare Part A and enrolled under
Parts B and D, and receiving full Medicaid benefits; and
 Reside in a FIDA Demonstration County: Bronx, Kings,
New York, Queens, Richmond, Nassau, Suffolk or
Westchester.
Must also meet one the following three criteria:
 Are Nursing Facility Clinically Eligible and receiving facilitybased LTSS;
 Are eligible for the Nursing Home Transition and Diversion
Waiver; or
 Require community-based LTSS for more than 120 days.
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Balancing Incentive Program (BIP)
The Balancing Incentive Program (BIP) is a funding opportunity
offered under section 10202 of the Patient Protection and Affordable
Care Act of 2010
Provides enhanced FMAP (+2%) to participating states to rebalance
Medicaid Long Term Services and Supports (LTSS) by increasing
access and expanding community services as an alternative to
institutional care.
Requires 3 structural changes:
• No Wrong Door/Single Entry Point network
• Core Standardized Assessment Instruments
• Conflict-Free Case Management
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BIP
Balancing Incentive Program
NYS’ BIP application was approved in March 2013, and the State
was awarded $598.7 million.
The BIP period is April 1, 2013 – September 30, 2015.
BIP will reinforce New York’s ongoing efforts to improve access to
home and community-based long term care services for those with
physical, behavioral health, and/or intellectual and developmental
disabilities throughout the State.
When BIP ends, the State must show an increase in the communitybased LTSS percentage from the baseline percentage by the end of
the BIP period.
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BIP
No Wrong Door/Single Entry Point Network:
Delivers consistent information about LTSS options whether an
individual seeks information from a 1-800 number, a website, or a
local office that is part of the State’s NWD/SEP network.
Provides individuals with assistance in accessing Medicaid or
non-Medicaid services. The State plans to:
 Expand NY Connects statewide;
 Add an interactive web-based screening tool to allow individuals
to help identify their LTSS needs; and
 Develop tools and training to ensure consistent information about
the LTSS available in communities across New York.
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DSRIP
Delivery System Reform Incentive Payment (DSRIP)
On April 14, 2014 New York has finalized terms and conditions
with the federal government for a waiver that will allow the
state to reinvest $8 billion in federal savings generated by
Medicaid Redesign Team (MRT) reforms.
The waiver amendment dollars will address critical issues
throughout the state and allow for comprehensive reform
through a Delivery System Reform Incentive Payment
(DSRIP) program.
The DSRIP program will promote community-level
collaborations and focus on system reform, specifically a goal
to achieve a 25 percent reduction in avoidable hospital use
over five years.
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DSRIP
The $8 billion reinvestment will be allocated in the following
ways:
• $500 Million for the Interim Access Assurance Fund –
temporary, time limited funding to ensure current trusted
and viable Medicaid safety net providers can fully
participate in the DSRIP transformation without disruption
• $6.42 Billion for Delivery System Reform Incentive
Payments(DSRIP) – including DSRIP Planning Grants,
DSRIP Provider Incentive Payments, and DSRIP
Administrative costs
• $1.08 Billion for other Medicaid Redesign purposes – this
funding will support Health Home development, and
investments in long term care, workforce and
enhanced behavioral health services
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DSRIP
The $8 billion reinvestment will be allocated in the following
ways:
• $500 Million for the Interim Access Assurance Fund –
temporary, time limited funding to ensure current trusted
and viable Medicaid safety net providers can fully
participate in the DSRIP transformation without disruption
• $6.42 Billion for Delivery System Reform Incentive
Payments(DSRIP) – including DSRIP Planning Grants,
DSRIP Provider Incentive Payments, and DSRIP
Administrative costs
• $1.08 Billion for other Medicaid Redesign purposes – this
funding will support Health Home development, and
investments in long term care, workforce and
enhanced behavioral health services
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Senior Supportive Housing Services
Program (SSHSP)
Department of Health (DOH) Request for Applications (RFA) to
establish Senior Supportive Housing Services Projects to serve lowincome, Medicaid-eligible seniors who are at risk of nursing home
placement or are homeless, or seniors who are transitioning out of
nursing homes into community living and require long term care
services.
Senior supportive housing services project is defined as the pairing
of capital assistance and supportive services within existing senior
housing communities.
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Senior Supportive Housing Services
Program (SSHSP)
1. Develop an innovative, high quality model to increase accessibility
within existing U.S. Department of Housing and Urban Development
(HUD) senior housing units as well as other senior housing units.
Features will include universal design modifications, renovation
and reconfiguration.
2. Conduct needs assessment with current residents of senior
housing to identify the types of supportive services necessary
to assist residents to remain in their current housing units.
Develop supportive services which will assist residents’ ability to live
independently in the community.
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Senior Supportive Housing Services
Program (SSHSP)
3. Develop an in-reach mechanism within existing senior housing
community to identify current residents who are Medicaid-eligible, and
at risk of nursing home placement. Develop a plan to determine if
current resident(s) may safely remain in their housing unit with the
addition of increased accessibility features and/or available supportive
services. Modify housing units and provide support services to current
residents.
4. Develop an outreach mechanism to identify low-income Medicaideligible seniors who currently are homeless or reside in the community
(not currently in low income senior housing), and who are at risk of
nursing home placement and seniors who wish to transition out of
nursing homes into community living who require long term care
services. Develop and implement a plan to assist these eligible seniors
to obtain low income senior housing with increased accessibility
features and supportive services.
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Senior Supportive Housing Services
Program (SSHSP)
5. Develop outcome measures and evaluation criteria which will
assist DOH in determining the value of the pilot project and senior
supportive housing services best practices for the target population.
6. Develop a process for data collection and reporting, including
completing the Supportive Housing Data Collection Tool and
submitting such data to the Department on a monthly basis.
 Develop new model of housing with services
 Will assist in defining line between housing and assisted living
 Applications were due May 30, 2014
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What’s Next?
Opportunities
• Greater cooperation between Homes and Community Renewal
(HCR), HUD, DOH, NYSOFA…
• Federal service coordination funding through Medicare /
Medicaid?
• DOH or NYSOFA funding for service coordination and support
services?
• Funding for service coordination through MLTC?
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What’s Next?
Service Coordinators in New York State
• NYSARSC: Keep on top of federal and state issues
• Advocacy and education needed by service coordinators about
service coordinators
• Advocate for funding – service coordination, resident services
with MLTC, construction, support services…..
• Get to know the MLTC plan options in your area
• Educate MLTCs on the role of service coordinators and how can
benefit residents.
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The Squeaky Wheel…
Advocacy!
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MLTC
Resources
LeadingAge New York:
http://www.leadingageny.org
Senior Supportive Housing Services:
http://www.health.ny.gov/funding/rfa/1212230202/
MRT Website:
http://www.health.ny.gov/health_care/medicaid/redesign/
MRT Listserv:
http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm
DSRIP Website:
http://www.health.ny.gov/health_care/medicaid/redesign/delivery_sys
tem_reform_incentive_payment_program.htm
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Contact Information
Ken Harris
Senior Policy Analyst
LeadingAge New York
13 British American Blvd
Latham, New York 12110
518.867.8383
kharris@leadingageny.org
www.leadingageny.org
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