WHAT’S HAPPENING:

The New York Times ran a story by Nina Berstein, Lives Upended by Disputed Cuts in Home-Care for Disabled Patientsdetailing the systematic problem of managed care plans reducing hours of service to members with disabilities who use home care and CDPA. Frequently, proper notice and/or legal justification for these reductions in hours is not given.

Please click here to view the full story.

For the full report as a PDF file, click here.

The following is an excerpt:

A detailed report by a coalition of more than 100 nonprofit groups found that since January 2015, Senior Health Partners of Healthfirst and at least two other companies have been systematically cutting the hours of home care to their disabled clients, typically without proper notice or legal justification. By law, only a change in a client’s medical condition or circumstance is supposed to allow a reduction.

The study was co-sponsored by Medicaid Matters, which is an advocate for Medicaid beneficiaries, and by the New York chapter of the National Academy of Elder Law Attorneys. It independently confirms similar allegations made earlier this year in a federal class-action lawsuit filed against Senior Health Partners and the New York State Health Department on behalf of disabled and aged clients threatened with cuts in home care. And it echoes the patterns explored in articles in The New York Times about the pitfalls of managed long-term care, which beginning in 2012 replaced a fee-for-service system with a flat rate for each patient enrolled, regardless of how much care was provided to them.

The flat rate “creates a perverse incentive” for Senior Health Partners, the lawsuit says. “The less care they provide to each individual, the more they earn.”

Between June 2015 and December 2015, the study found a sixfold increase in hearings that challenged home-care reductions. In more than 90 percent of those 1,042 hearings, the companies lost or simply withdrew proposed cuts when challenged. Though Senior Health Partners is only one of more than 20 such plans in New York, serving about 12 percent of managed long-term care clients, it accounted for 56 percent of those hearings.

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