Education Key To Successful Managed Care Transition

As the heat of summer continues, so too does the transition to managed long term care for thousands of people receiving both Medicare and Medicaid.  Long Island and Westchester have almost completed their switch by now.  New York City continues to enroll more and more individuals, with well over half of those who will have to switch to managed long term care having done so.  Now, we watch Rockland and Orange counties, where those who will soon need to switch have gotten their first letters.

So what do we know now?  Basically, what we thought initially has borne out.

Some plans have proven to be very good for consumers and fiscal intermediaries.  Some plans have proven to be problematic for consumers and fiscal intermediaries.  Most often, plans are neither universally good or bad.  What we see are positives for some consumers and fiscal intermediaries and negatives for others.

In all cases, CDPAANYS is continuing our work advocating with the plans and the Department of Health.  We are continuing to offer educational sessions to any plan that desires it.  This combination of efforts is ensuring as smooth a transition as possible.  It is also serving to eliminate the discrepancies in the program that existed due to different county interpretations of a program that existed without regulations for 25 years.

This last point is what is most important.  This is one of the primary reasons CDPAANYS was so supportive of the transition to managed long term care.  The previous system was broken and heavily divided, with 57 different CDPA programs running throughout the state.  Some were good.  Some were bad.  Some were illegal (waiting lists!).

Because the plans implemented CDPA after the regulations were in place, there is a standard set of rules they must abide by.  Because of CDPAANYS advocacy, these regulations are enforced through the contracts plans sign with the State, the fiscal intermediary and the consumer.  This has resulted in a program that looks very similar statewide, regardless of which plan you are in.

While many positive changes are being made, there are still problems to contend with.  More education is needed, and will always be needed.  It is a two-way street; plans need to learn more about CDPA, and consumers and fiscal intermediaries need to learn more about plans.  For, while CDPA is new to plans, managed care is new to most consumers and fiscal intermediaries.  For this to work, all entities must recognize they have more to learn and take the initiative to increase their understanding and knowledge of the others.

CDPAANYS is glad we can continue to play a role here.  On October 9th and 10th, the organization’s 11th Annual Conference, once again at the Hilton Garden Inn in Troy, NY, will focus on how plans, consumers and fiscal intermediaries can benefit from the ongoing transition.  We will host a number of sessions aimed at helping consumers, fiscal intermediaries and plans continue to learn more about how CDPA works and how managed care and CDPA can work together.  Among other things, the conference will feature Lee Schulz of IndependenceFirst in Wisconsin.  As many know, Wisconsin has already transitioned to managed care.  Lee will facilitate a discussion of what he observed during the transition in his home state, and then answer questions about what New York can learn from his experiences in Wisconsin.

We strongly encourage everyone to take advantage of this opportunity.  Early Bird discount rates are available for two more weeks.  Be sure to watch CDPAANYS’ web page and social networks for ongoing updates about our conference.

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