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Old 08-09-2016, 10:37 AM
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Laura Laura is offline
Join Date: Sep 2006
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Default Report Issued Exposing Patterns of Arbitrary Cuts in Home Care Hours by Some Managed

Report Issued Exposing Patterns of Arbitrary Cuts in Home Care Hours by
Some Managed Long Term Care Plans

Medicaid Matters NY, a statewide coalition, along with the New York
Chapter of the National Academy of Elder Law Attorneys, issued a Report
called "Mis-Managed Care: Fair Hearing Decisions on Home Care Reductions
by MLTC Plans: July - December 2015." The Report, issued in July 2016,
can be downloaded here. The report was featured in a story in the New
York Times published on July 21, 2016 – Insurance Groups in New York
Improperly Cut Home-Care Hours for Disabled Patients, Report Says, Follow
up articles were published in Crain's Health Pulse.

The Report identified every fair hearing decision posted in the OTDA Fair
Hearing Decision Archive concerning reductions by MLTC plans during the
last six months of 2015. The 1,043 decisions reveal a pattern of
arbitrary and illegal reductions in hours of home care services. While
most members win these hearings, for every member who had the wherewithal
to request, travel to, and present their case at a hearing, undoubtedly
there were many who could not. The report calls on the State to restore
services for these vulnerable New Yorkers, to stop plans from engaging in
these illegal reductions, and to improve its oversight of these private
plans spending public dollars.

The number of decisions issued each month increased six-fold during the
six-month period. In 90% of the 1,043 hearing decisions identified, MLTC
plans’ attempts to cut services were thwarted, either by a plan member
winning the hearing or because the MLTC plan failed to show up to defend
the proposed reduction at the hearing. In a smaller but significant
percentage of the decisions, the case was settled through an agreement in
which the member -- often without an attorney to advise them -- agreed to
accept some reduction in hours that was less than the plan originally
proposed. Although most of the hearings identified for the report
involved people in New York City, seniors and people with disabilities
struggle with arbitrary home care reductions statewide.

Get Help -- Representation is available for people facing reductions in
services by MLTC plans. Contact ICAN - the Independent Consumer Advocacy
Network - the State ombudsprogram for MLTC, FIDA, and other Medicaid
managed care programs providing long term care services. Call (844)
614-8800 TTY Relay Service: 711.
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