Coalition to Protect the Rights of New York's Dual-Eligibles

20 Pages·2012·0.53 MB·English

Coalition to Protect the Rights
of New York’s Dual-Eligibles
Testimony of the Coalition to Protect the Rights
of New York’s Dual-Eligibles
on
Medicaid Transition to Care Management for Long-Term Care
PART I – CONCERNS ABOUT IMPLEMENTATION OF MLTC
Submitted to:
The Assembly Committee on Health
and
The Assembly Committee on Oversight, Analysis And Investigation
Submittedby
ValerieBogart,Esq.,917-817-9837,[email protected]
SusanDooha,Esq.,Exec.Director,CenterforIndependenceoftheDisabledNY
[email protected] [phone]
TrilbydeJung,Esq.,EmpireJusticeCenter (585)[email protected]
OnBehalfoftheCoalition
December7,2012
PartIIofCoalitiontestimony–presentedbyDouglasCoggin-Callahan,MedicareRights
Center,onconcernsreexpansionofMLTCtoFullyIntegratedDualAdvantage(FIDA)
PartIII ofCoalitionTestimony–presentedbyNoraChaves,CommunityHealthAdvocates,
onNeedforOmbudsprogramforMLTC
TheCoalitiontoProtecttheRightsofNewYork’sDualEligibles isacoalitionofdisability
rightsandseniorsrightsadvocates,consumers,communityadvocacyorganizations,and
lawyersrepresentingpeoplewithdisabilitiesandolderNewYorkers. We providethis
testimonytoexpressconcernsabouttheimplementationofthe1115waiverinNewYorkState
toincludemandatoryenrollmentofDualEligibleswhoreceiveMedicaidpersonalcareand
othercommunity-basedlong-termservicesinManagedLongTermCare(“MLTC”)plans.
TheMLTCplans,providers,andconsumersallwantasystemthatachievesthecommongoalof
providingadequateandnecessaryservicestoenablepeopletoliveinthecommunity,in
furtheranceofthegoalsoftheADAandOlmstead. However,theStateisrushinginto
implementingamonumentalchangeinhowatleast85,000individualsnowreceiveMedicaid
community-basedservicesinNewYorkCity,tobefollowedlaterstatewide,withoutsufficient
safeguardstoensurethatenrolleeswillreceivetheservicestheyneedinthecommunityto
avoidinstitutionalization. Weareparticularlytroubledbyanticipatedproblemswithcapacity,
enrollment,gapsandinterruptionsincoverage,aswellaswiththeprogram’slackofproper
incentives,dueprocessprotections,oversight,andabilitytoabsorbspecialprogramscurrently
providingcriticallyimportantservices. Ourconcernsandourrecommendationsaresetforthin
detailbelow.
1. TimingandCapacity--Mandatoryenrollmentshouldbesloweddownuntil systemic
concernsdescribedbelowareaddressed,andthensolelywithnewapplicants-- over1,000
personspermonthinNYCalone,whichwouldprovideanopportunitytoworkoutandtestthe
newsystems.Auto-assignmentandmandatoryenrollmentofcurrentpersonalcare recipients
shouldbesuspendedforatleastsixmonths,toallowtheState,inconsultationwith
stakeholders,tomonitortheimpactofmandatoryenrollmentuponnewapplicantsandadjust
thecapitationratesandothersystemsasnecessary.
Evenwithlessthan1000peopleauto-assigned–thefirstinNovember2012--enrollmentin
MLTCplansinNYChasskyrocketed,duetomarketingbyplansandinresponsetoMaximus’
letterssenttoover10,000currentrecipientsexplainingthatenrollmentisnoworwillshortlybe
mandatory.
TotalMLTCEnrollmentNYC–MLTConly,withoutPACEorMAP1
Dec-10 Dec-11 Feb-12 Jun-12 Sep-12 Oct-12 Nov-12
32,264 39,487 42,684 45,634 50,760 54,947 59,102
Therushedenrollmentchallengesnotonlytheplans’capacitytoabsorblargenumbersof
enrollees,butalsotheirabilitytoserveenrolleeswithmoreextensiveneedsforhomecareand
otherservices. WequestiontheState’sclaimthatthecurrentvoluntaryMLTCplansare
equippedtoservetheinfluxofnewmembersbecausetheyalreadyservememberswitha“high
levelofimpairment.” TheStateadmitsthatthepopulationhistoricallyservedbyMLTCasa
voluntaryprogram“…islessimpairedthanthenursinghomepopulation,”yetitfailsto
1http://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/
2
comparetheMLTCpopulationtotheMedicaidpersonalcarepopulationnowbeingenrolled en
masse. AccordingtotheUnitedHospitalFund,“…two-thirdsofNewYorkCity’spersonalcare
beneficiarieshadcomparablelevelsofneed[tonursinghomeresidents]onkeyindicators,such
asfunctionalandcognitivestatus,asindicatedbyresourceutilizationgroup(“RUG”)
scores….”2 Moreover, inthelastsixyearsofvoluntaryMLTCenrollment,manyoftheMLTC
planshave“cherry-picked”alowerneedpopulation, leavingahigher-acuitypopulationinthe
personalcareprogram.
1.a. Auto-assignmentalgorithmsmustbeintelligent,basedonconsumer’spreferred
providers,andbasedonplanexperienceandquality. Weareconcernedthatfiveofthe15
MLTCplansinNYCarebrandnewwithnotrackrecordorexperiencewithMLTC. Whatis
theDepartment’sstandardfordeterminingthataplanisreadyforauto-assignment? Whatare
thequalitycriteriausedforthisalgorithm? Plansshouldbeassignedbasedinpartontheir
includingtheconsumer’sexistingproviderstominimizedisruption. DOHmustclosely
monitorauto-assignmentandsuspendauto-assignmentwhenitexceedsaspecifiedpercentage
ofenrollments,sinceallagreethatconsumerchoiceiscritical.
2. Consumers NeedBetterInformation toMakeInformedChoices inEnrollment,and
theNetworkofCommunityPartnersMustbeEducatedAbouttheSweepingChanges.
MLTCrepresentsasea-changeinaforty-yearoldsystemforaccessingMedicaidhomecare,
shiftingfromthecommunity-basedCASAofficesthatwereaone-stopcenterforbothMedicaid
andhomecareapplications. Consumersandstaffofcommunity-basedorganizationsare
confusedandanxiousaboutchangestheydonotunderstand. Consumersmustnotonlyselect
oneofthreedifferenttypesofplans --MLTC,PACE,orMedicaidAdvantagePlus--butmust
selectfromover25individualplans,withnewplansaddedeverymonth. NewYorkState
DOHand/orMaximus/NewYorkMedicaidChoiceshouldbeconductingcommunityand
professionaleducationprogramstoinformconsumers,theirfamiliesandadvocatesabouttheir
choices. Itisalsoimportantthattheinformationisprovidedinalinguisticallyandculturally
competentmanner.
Unlikethe“PlanFinder”forMedicarePartD,thereisnosinglewebsitewhereconsumerscan
comparetheover25plansnowavailableinNYC–toseewhichplans’networksincludetheir
preferredproviders. WhentheycallMaximusforphonecounseling,theonlyinformation
availableiswhichprovidersareintheplans’networks. Thereisnoobjectivefactual
informationaboutthetrackrecordofeachplaninauthorizingservices. Consumersneedto
2 AleneHokenstadetal.,AnOverviewofMedicaidLong-TermCareProgramsinNewYork(UnitedHospital
Fund2009),postedathttp://www.uhfnyc.org/publications/880507;seealsoS.Samis&M.Birnbaum,
MedicaidPersonalCareinNewYorkCity:ServiceUseandSpendingPatterns(UnitedHospitalFund2010),
postedathttp://www.uhfnyc.org/publications/880720(Over70percentofNewYorkCitypersonalcare
recipientsina2003cohorthadatleastonechronicdisease,andoverhalfhadmultiplechronicdiseases,
withoneinfourrecipientshavingamentalhealthdiagnosis.)
3
knowtheextenttowhichparticularplansauthorize24-hourcareorotherserviceplans, andthe
numberofaplan’smembersplacedinanursinghomeratherthanprovidehomecare.Thisisall
informationwhichtheplansreporttotheStatequarterly,andwhichshouldbemadeavailable
publicly.3 ThenewconsumerguideissuedbyDOHdoesnotincludethistypeofdata–and
insteadreliesonsubjectiveinformationbasedonself-reportingbytheplans. See
http://www.health.ny.gov/health_care/managed_care/mltc/consumer_guides/index
Consumeradvocacyorganizationsshouldbefundedtoprovidetrainingtothemyriad
grassrootsneighborhood-basedorganizationsthatprovideservicestotheaginganddisabled.
3. AnIndependentEntityShouldMakeConflict-FreeDeterminationsofEligibilityfor
MLTCEnrollment
Theinitialdeterminationofwhetheranindividualiseligibleforcommunity-basedlong-term
careservicesmustbemadebyanentitythathasnoconflictofinterestinmakingthisdecision.
AssigningtheMLTCplantheroleofdeterminingwhetheranindividualiseligibleforservices
allowstheplansto“cherrypick”potentialenrollees.AnMLTCplanmaydenyenrollmenttoan
individualwhoissaidtobe“notsafe”inthecommunity,or wholacksaso-called“backup”
persontofillinwhentheaidedoesnotcome. Inourexperience,theindividualsdenied
enrollmenthaveextensiveneedsandwouldneedhighhoursofcare–asmuchas24hours/day.
Sincethiscareiscostly,theMLTCplanhasafinancialinterestinrefusingenrollmenttothese
individuals.
WithnosingleoutsideentitydesignatedtodetermineeligibilityforMLTCservices,theconsumer’sright
toappealiseviscerated. Inthesituationswe’veseen,theMLTCplandidnotprovideawritten
noticeofitsdecisiontorejectenrollment. Theconsumerdidnotknowtheirappealrightsor
thebasisofthedecision. Moreover,ifseveralotherplansdeniedenrollment–forthesame
reasons –theconsumermustappealeachplan’sdecisionseparately. Afairhearingdecision
findingoneplan’sdenialwasimproperwouldnotnecessarilybebindingonanotherplan. The
specterofmultipleappealsforthesameconsumerisraised,burdeningtheState’shearing
systemaswellastheplan’sresourcesandtheconsumer.
Whilenotperfect,thepastsystematleastaffordsanunbiasedinitialdeterminationof
eligibility. ThelocalMedicaidoffice(HRACASAinNYC)wasresponsiblefordetermining
eligibilityforpersonalcareservices. DenialsbyHRAwerestatedinawrittennotice,whichthe
consumercouldappealatafairhearing. WhentheStatereversedHRA’sdenialafterafair
hearing,thatdecisionwasbindingonHRAandallitscontractinghomecareprovideragencies.
Thustheissueofeligibilitywasfinallyresolved(atleastuntiltheindividual’smedicalcondition
changed).
3 These“costreports”filedwiththeStatefor2010showdatasuchasHomeHealthCareandPersonal
CareServicesHoursProvidedbyMLTCandPACEPlansinNYS(2010) postedat
http://wnylc.com/health/afile/169/324/;andPercentageofmemberswhowereinanursinghomeforthe
entirequarter(2010)postedathttp://wnylc.com/health/afile/169/325/
4
Anewentitywoulddeterminewhetheranindividualcouldcontinuetoliveinthecommunity
withacombinationofthevariouscommunity-basedservicesintheMLTCbenefitpackage.
Factorswouldincludewhethertheindividualhadsomeoneto“direct”theircareifthe
individualwasnotself-directingbecauseofdementiaorothercondition. Giventhewide
varietyofservicesavailable,fewpeopleshouldbedenied.
4. IncreasedConsumerProtections&StateOversightAreNeededtoEnsureCompliance
withOlmstead.
A. Toincentiveprovidingcommunity-basedratherthaninstitutionalcare,MLTCplans
shouldberequiredtocontractwithallnursinghomesthatmeetspecifiedquality
measures. Otherwise,plansmaydis-enrollhigh-needmemberswhomtheydetermine
requirenursinghomeplacement. Thefactthatnursinghomecareispartofthebenefit
packageforMLTCispotentiallyanincentiveforplanstoprovideservicestokeep
membersathome. Sincenursinghomecareisusuallymorecostlythancommunity-
basedcare, theplanhasanincentivetoavoidthosehighcosts. Butforsomepeople
withthemostseveredisabilities,thecostofcareathomecanbeasexpensiveoreven
morecostlythannursinghomecare. Now,planscanavoidthecostsofprovidingANY
caretothesehigh-needindividuals. Here’showitworks. Theplandeterminesthatthe
person’sneedscanonlybemetinanursinghome,andinformstheconsumerofwhich
nursinghomesareinitsnetwork. Theconsumerdoesnotlikethechoicesofnursing
homes. Inordertogotoherpreferrednursinghome,shecandisenrollfromtheplan
andobtainFFSMedicaidforthenursinghomeofherchoice. ThePlanhasthusavoided
providingcaretoahigh-needindividual,creatinganincentivetoplacehigher-cost
membersintonursinghomesratherthantoprovideadequatecommunity-based
servicestopreventinstitutionalization.
B. Plansmustbegivenuniformstandardsfordeterminingmedicalnecessitythatare
consistentwithestablishedpolicyandprecedent. Mandatoryenrollmentmustbe
sloweddownatleastuntiltheStatehastested,revised,solicitedinputfromconsumers
andotherstakeholders,andconductedthenecessarytrainingforanewUniform
AssessmentToolthatwillbeusedbyMLTCplans. TheStatemustensurethatplans
providepersonalcareandotherservicesinthesameamount,duration,andscopeasis
availableundertheStateplan.Instead,planshavediscretiontomakeuptheirown
standardsofmedicalnecessity.
Unlikemuchoftheprimaryandacutemedicalcareauthorizedundertraditional
managedcareplans,theauthorizationoflong-termcare,particularlyhomecare
services,musttakeintoaccountmyriadfactorsthatarenotsolelymedical–e.g.the
individual’savailablesocialnetworkofinformalcaregivers,hisorherhousingsituation,
thelogisticsneededforbasichousekeeping,shopping,andothertasks. Mandatory
enrollmentmustbepostponedatleastuntiltheStatehasfinishedtesting,revising,
andsolicitingconsumers’andotherstakeholders’inputabout,anewUniform
5
AssessmentToolthatwillbeusedbyMLTCplans.4 Thelackofauniformtool results
ininconsistentandarbitrarydeterminations,includingoutrightdenialsofservices.
Inadditiontoauniformassessmenttool,thestandardsusedtoassesstheamountof
servicesnecessarymustcomplywithstandardssetbyregulation,litigationand
administrativeprecedentinNewYorkStateoverdecades. Forexample,state
regulationsrestricttheuseof“task-basedassessment”forpeopledeterminedtohave24-
houradayneeds(18NYCRR505.14(b)(5)(v)),andaStatedirectiveprohibitsthedenial
ofpersonalcareservicesneededtoassistaconsumertosafelyperformbasicactivitiesof
dailyliving–apolicythatisvitaltoprotectpeoplewhohavedementia.5
C. AnOmbudsprogramShouldbeCreatedto InvestigateConsumerComplaints,
MonitorSystemicProblemsandProposalsbyanMLTCPlantoPlacea Consumerin
aNursingHome. WeendorsetheDOHproposalfortheFullyIntegratedDual
Advantage(FIDA)programforestablishmentofanOmbudsprogram. Thisshouldbe
creatednowtoprovidevitaloversightandconsumerassistanceintheimplementation
ofMLTC. OnecriticalroleofanOmbudsprogramwouldbetoreceivenoticeofany
proposedactionbyanMLTCplantodiscontinuecommunity-basedservicesandplace
thememberinanursinghome. TheOmbudsprogramwouldascertainwhetherthe
membervoluntarilyagreestoplacementbasedonaninformedchoice,andwhether
community-basedservicescouldbeprovidedasanalternative.
ThereareinsufficientproceduralandoversightmechanismstopreventMLTCplans
fromutilizingexcessivenursinghomeservicesinsteadofcommunity-basedcare. Even
now,withalower-acuityvoluntaryenrollmentpopulation,costreportsfiledwiththe
StateindicatethatsomeMLTCplansspendasmuchas11.4%oftheircapitationon
nursinghomecare. TheMLTCmodelcontractgivesMLTCplanstotaldiscretionin
determiningwhentoutilizenursinghomeservicesthatareincludedinthecapitation
rate. Anombudsprogramwouldbeonecrucialsafeguardtoensureaccessto
community-basedcare.
D. ImprovementsofRiskAdjustmentofCapitationRatesareNeededtoEnsurethat
PlanshavetheResourcesandIncentivetoprovideCommunity-BasedCaretoHigh-
NeedIndividuals. Whileratesarerisk-adjustedtosomeextentforMLTCplans,the
adjustmentisnotsufficienttotakeintoaccounttheinfluxofhigher-needindividuals
transitioningfromtheCASApersonalcarepopulationnow,andarenotsufficientfor
planstoprovidethecareneededforthemostvulnerableconsumers. Seeour
recommendationsinIncentivesforCommunity-BasedServicesandSupportsinMedicaid
ManagedLongTermCare:ConsumerAdvocateRecommendationsforNewYorkState(March
2012),postedat.http://wnylc.com/health/download/304/.
4 TheStatealsomustconducttraininginordertoeffectivelyimplementsuchauniformassessmenttool.
5 SeeNYSDep’tofHealthGIS03MA/003,
http://www.health.state.ny.us/health_care/medicaid/publications/docs/gis/03ma003.pdf.
6
E. StateDOHneedsincreasedstaffingandtechnologicalresourcestoconducttherobust
stateoversightthatiscriticallyneeded,includingexpansionofQualityAssurance
ReportingRequirements(QARR)toinclude metricsapplicabletomemberswhoneed
long-termcare. Withthousandsofvulnerablepeopleatriskoflosingstablelong-term
Medicaidhomecareservicesinthistransition,theStatemustdomorepro-active
monitoringthansimplyobtainingreportsfromMLTCplansonthenumbersof
grievancesorhearingsfiled,orconductingconsumersatisfactionsurveys. Thevast
majorityofconsumers,whobydefinitionareelderlyand/ordisabled,manywithmental
illness,willnotutilizethegrievanceandhearingsystems. CMShaswiselyrequiredin
theSpecialTerms&Conditions:
…Forinitialimplementationoftheauto-assignedpopulation,theplansmust
submitdataforstatereviewonamonthlybasisreportinginstanceswhenthe
planhasissuedanoticeofactionthatinvolvesareductionofsplitshiftorlive-in
servicesorwhentheplanisreducinghoursby25percentormore.6
AsofNovember14,2012,theStatehadnotyetdesignedasystemorprovided
instructionstoplanstoreportthisdata–letaloneassembledstaffandresourcesto
monitorandrespondtothedataasitisreceivedinrealtime. Trueoversightofplan
decisionstoreducehoursmustbedoneimmediately,withfollow-up --inorderto
preventpotentialharm. ThedatarequiredbyCMSshouldbesharedinrealtimewith
anoversightpanelthatincludesstakeholderrepresentativesincludingconsumer
advocatesandtheombudsprogram.
Additionally,theStatemustrandomlysampleapprovalsanddenialsforotherservices
–i.e.motorizedwheelchairsandotherdurablemedicalequipment,transportationfor
medicalcare,dentalcareandeyecare,andotherservicescoveredinthepackage.
Oversightisalsoneededtoensuretimelyauthorizationsforservices.
QualityAssuranceReportingRequirements(“QARR”)reportingdatamustbeexpanded
toincludeadditionalmetricsthatareapplicabletomemberswhoneedlong-termcare
(e.g.abilitytoperformactivitiesofdailyliving,prevalenceofdecubitusconditions,
usageofincontinencepadsasopposedtoassistingwithtoileting,incidenceoffallsand
otheraccidents,temporaryandpermanentnursinghomeplacement.)
DOHhasindicatedthatitlacksstaffingtomake“secretshopper”callstoplanstotest
theaccessibilityoftheirMemberServiceshotlines,andtotestcapacityandavailability
oftheirprovidernetworks. Suchmonitoringiscriticaltoensureaccess.
6 CMSSpecialTerms&Conditions,PartnershipPlan, amendedAugust2012,postedat
http://www.health.ny.gov/health_care/medicaid/redesign/docs/2012-08_partnership_amendment_stc.pdf
(¶28.d.p.17)
7
F. ThreeChangesareRecommendedtoStrengthenDueProcessRights
AnyreductionbyMLTCplansinthepersonalcareservicesthatwerepreviously
determinedtobemedicallynecessaryispotentiallylife-threatening. Over40percentof
personalcarerecipientshavebeenreceivingpersonalcareservicesforatleastsevenyears
duetolong-termchronicconditions.7 Therefore,consumersmusthavefulldueprocess
protectionstochallengeanyreductionbyMLTCplansoftheirpersonalcareservices. Three
Statepoliciesthreatenthesefundamentalprotections.
1. “Exhaustion”ofinternalappealswithintheplanisbeingrequiredbytheState--
forthefirsttimeeverinMedicaidmanagedcare–andwithoutlegislativeauthority
--beforeonemayrequestafairhearing. Thisrequirementthreatenstobaraccessto
appealsforthousandsofvulnerablepeopleusedtotheoldlong-timesystemof
requestingafairhearingimmediately. Wehavealreadyseenaconsumerrequesta
hearingwhenanMLTCplandeniedanincreaseinhomecarehours,onlytohaveher
hearing dismissedmonthslaterbecauseshehadnotrequestedaninternalappeal. By
thattime,itwastoolatetorequestaninternalappeal.
Thelegislatureshouldclarifythatexhaustionisnotrequiredbeforerequestinga
hearing. Yetweunderstandthatefficienciescanbeachievedifplansreviewtheirown
determinationsbeforeahearing. Tothatend,anyfairhearingrequestcouldbe
deemedtobearequestforaninternalappeal,andtheStateOfficeofAdministrative
HearingscouldnotifytheMLTCplanofany fairhearingrequests. Whilethehearing
isbeingscheduled,theplancouldconducttheinternalappeal. Iftheissueis
resolved,thehearingwouldnotbenecessary.
2. TheStatemustensurethatanMLTCmemberhasthedueprocessrighttocontinue
receivingservicesunchanged,as“aidcontinuing”pendinganinternalappeal
and/orfairhearing,beforeanMLTCplanreducesorterminatesservicesthatwere
previouslyauthorizedbythelocalMedicaidprogrampriortoMLTCenrollment,or
bytheplan. WeunderstandthatCMSmayberevisingitswaiverapprovaltorequire
“aidcontinuing”rightsifaplanreducesservicesattheinitialtransitionfromthe
Medicaidhomecareprogramaspreviouslyrun. Thisisanencouragingstart,but
needstobebroadenedsothatallMLTCplansmaynotarbitrarilyreduceservicesat
anytime,withouttheconsumerhavingtherighttoseekreviewwithservicescontinue
unchangedpendingthatreview. Thisisafundamentaldueprocessrightguaranteed
bytheDueProcessclauseoftheFourteenthAmendmenttotheConstitution,sincethe
SupremeCourtdecisioninGoldbergv.Kelly,397U.S.254(1970).
3. LackofModelNotices–DOH hasindicatedthatPlanshavenotbeengivenmodel
noticeformatswithstandardized,testedlanguage. Thisisveryconcerning,asthe
messageiscomplicated,readabilityandliteracyissues,inadditiontoADAissuesare
critical. JustasDOHhasprescribednoticesforallthelocalDSS,thesameis
7 S.Samis&M.Birnbaum, MedicaidPersonalCareinNewYorkCity:ServiceUseandSpendingPatterns
(UnitedHospitalFund2010),supra,atpp.iii-iv,6-8.
8
necessaryforthemanyMLTCplanstoensuretheyincludetheminimuminformation
inaclearway.
G. DOHmustcreate,inpartnershipwithconsumersandtheiradvocates,anAmericans
withDisabilitiesActComplianceAppendixtothecontract,andmonitorits
implementationasasteptowardsdisabilityliteracy.
Withitsemphasisoninterdisciplinarycarecoordinationandavoidanceofinappropriate
relianceoninstitutionalsettings,MLTCpresentssomeopportunitiestoimprovethecare
ofpeoplewithdisabilities.However,MLTCwillonlyachievethispromiseifitattends
tothedisabilityliteracyofMLTCplans. DisabilityliteracyforMLTCplansmaybe
definedasthecapacitytounderstand,communicate,andpartnerwithpeoplewith
disabilitieswithdemonstratedunderstandingoftheirperspectivesandbeliefs
concerninghealthbehavior. Anexamplewouldberecognitionofthepreferenceforself-
directionandinformedchoice.Lackoftrainingondisabilityliteracyissuesand
problem-solvingtoremovebarriersforhealthplanadministrators,staffandcare
practitionerscreatesaverysignificantbarriertoeffectivehealthcare.
DisabilityliteracyiscriticaltothesuccessoftheMLTCprogram. NewYorkState
recentlyhasobservedthatpeoplewithdisabilitiesrequiringsignificantassistancehavea
lowerhealthqualityoflife,engageinbehaviorssuchassmokingthatpresenthealthrisks
andengageinfewerhealthpromotingactivitiessuchasexercise.Theyexperience
chronicconditionsatahigherratethanpeoplewithoutdisabilities.8 Theyalso
experiencehealthdisparitiesandfacesignificantproblemsaccessinghealthservices. For
example,adultswhoaredeafreportpoorhealthwithgreaterfrequencythanpeoplewho
arenotdeaf,lackinterpretersinhealthsettingsandfailtoreceivehealthinformationand
instructionsfrompractitioners. Adultswithdevelopmentaldisabilitiesareathigherrisk
ofobesity,cardiovasculardiseaseandhypertensionthanpeoplewithoutdevelopmental
disabilities. Theyencounterproblemsworkingwithproviderswhodonotgivethem
enoughtimetoundress,communicateorunderstandinstructions.9
Managedlong-termcarecanfulfillitspromiseofcoordinatingcareandavoiding
expensiveandoverlyrestrictiveinstitutionalplacement,onlyifitaddressesdisability
literacyissues.
OneoftheCoalitionmembers,theCenterforIndependenceofDisabledofNY,reviewed
theADAcomplianceplans(AppendixJtothemodelcontract)of16NYCMLTCplans
obtainedthrougha2012FreedomofInformationActrequest. Whilealltheplans
submittedshowedseriousdeficiencies,itappearedthatnoStateevaluationofthe
AppendixJplanshadoccurredorthatcorrectiveactionhadbeentaken.
8 NewYorkStateDepartmentofHealth,DisabilityandHealthProgram,“ChartbookonDisabilityin
NewYorkState,2007,ResultsfromtheBehavioralRiskFactorSurveillanceSystem.”2008.
9 NationalCouncilonDisabilities,“TheCurrentStateofHealthCareforPeoplewithDisabilities,”2009.
9
WhatkindsofdeficienciesintheADAplanswereevidentintheMLTCcontracts?
 Oneinthreeplansdoesnotprovideevidencethattheyidentifypeoplewithdisabilities;
 Noneofthe18plansprovideshasaprocedureforidentifyingandrecordingrequestsfor
accommodationsforpeoplewithdisabilitiesorthedispositionofthoserequests;
 Onlytwoofthe18plansprovidenoticetoenrolleesoftherighttoreasonable
accommodations—itislimitedtohearingandvision-relateddisabilities.
 Notoneplanprovidesdetailedguidanceonhowtorequestareasonable
accommodation,howandwhentherequestwillbeaddressedandbywhom.
 Noplansprovideaccommodationsforpeoplewithpsychiatricdisabilities,ormention
learningdisabilitiesorintellectualdisabilities.
 Planslistaverynarrowspectrumofaccommodationsanddonotindicatethatthe
accommodationslistedarenonexclusive.
 Notoneofthemanagedlong-termcareplanstrainsitsemployeesonthepoliciesand
specificproceduresforADAcomplianceofthemanagedlong-termcareplan.
 NoplangivesnoticeoftherighttocomplaintotheU.S.DepartmentofHealthand
HumanServicesOfficeofCivilRights.
AnAmericanswithDisabilitiesActComplianceAppendixtothecontractwouldmake
provisionforeradicationofphysical,communications-related,programmaticand
attitudinalbarriers. Forexample,MLTCPlansmustberequiredtohaveand/ordevelop
anexperienceandknowledgebasetoservepeoplewithsignificantdisabilities. Among
issuestobeconsideredare:
A. thephysicalaccessibilityofadministrativeandproviderfacilities;
B. willingnessandcapacitytoprovidewrittenmaterialsinalternate,accessible
formats;
C. expertiseinassessingneedsforadaptiveequipmentandenvironmental
modifications,includingwheelchairfittingandseatingandhomemodifications,
withpoliciesandpracticesforapprovalofdurablemedicalequipmentand
transportationthatareconsistentwithapplicablelawsandpromoteindependent
living;
D. understandingof,andthecapacitytoaddress,thehousingandsocialserviceneeds
ofparticipants;
E. aprovenanddocumentedcommitmenttomaintainingpeopleinthemost
integratedsetting;
F. policiesthatfacilitatetheprovisionofreasonableaccommodationstopeoplewith
disabilities;and
G. provisionofopportunitiesforplanparticipantstoparticipate,inasignificant
manner,inthedevelopmentofplanpoliciesandpractices.
10