03012013 DD population optional MLTC Enrollment Request Letter


Nirav R. Shah, M.D., M.P.H., Commissioner
Sue Kelly, Executive Deputy Commissioner

March 1, 2013

Ms. Cynthia Mann
Center for Medicaid and CHIP Services
7500 Security Boulevard, MS S2-26-12
Baltimore, Maryland 21244

Dear Ms. Mann:

I am writing to request a technical amendment to the Special Terms and Conditions of the Partnership Plan Medicaid Section 1115 Demonstration Waiver (11-W-00114/2) to allow for the development of a limited number of managed long term care plans (MLTCPs) to coordinate services for individuals with intellectual or developmental disabilities (1/DD). Enrollment in these plans will be strictly voluntary.

These specialized MLTCPs will have the same benefit package as is currently approved, but the rate developed for these specialized plans will be actuarially certified based on the unique needs of the population to be served, and will reflect that most Medicaid services under the umbrella of the Office for People With Developmental Disabilities (OPWDD) will remain outside of the MLTCP capitation rate and will be reimbursed by fee-for-service Medicaid until such time as CMS approves future amendments to incorporate OPWDD services and populations more broadly.

Governor Cuomo has submitted legislation to effectuate needed changes to develop these specialized MLTCPs, and passage by the Legislature is anticipated. Attached to this letter is a page of the August 31, 2012 Special Terms and Conditions with the proposed changes being sought. We hope to have your approval of this request by May 1, 2013 to provide ample time for implementation of these MLTCPs by July 1, 2013.

Thank you for your consideration of this request. If there are questions regarding this submission, please contact Mark Kissinger, Deputy Commissioner of Long Term Care at (518) 402-5673.


Jason A. Helgerson
Medicaid Director
Office of Health Insurance Programs


M. Kissinger
C. Burke
M. Seeley
J. Ulberg
J. Moran
K. Delaney