Why is ICS closing its managed long-term care plan (MLTC)? How will the changes affect ICS members, including those with and without a physical disability? What is the new care management organization ICS is opening?
Members have been asking these kinds of questions of ICS leadership and staff since learning in January that after nearly 20 years of operation, ICS is closing its MLTC plan on March 31 and moving most of its members to VNSNY CHOICE MLTC on April 1.
ICS member Stephanie Wallace had a chance to ask these questions of ICS Director of Community Engagement Danny Perry on a new episode of Independence Radio. The ICS podcast is available here.
Danny has been traveling to various events where ICS members gather to explain the transition and talk about the new ICS Health Home for people with physical disabilities, which is open for business on April 1. If anyone is expert in the subject, it’s Danny. And Stephanie’s questions were not just academic; as a member, she has a vital interest in the answers.
The burning question on everyone’s mind is why is this happening?
“A percentage of our members have complex and severe disabilities,” Danny explains. “And unfortunately, it’s very costly. We’ve tried to get the appropriate reimbursement rate, because what happens is, we get paid a certain rate per member, per month. And it doesn’t matter if that person receives four hours of home care per day, or if they receive twelve to twenty-four hours per day. We have a high percentage of our members who fall into that twelve to twenty-four hour bucket. And as such, we’ve come across a huge deficit that we’ve been trying to work through for many years, and it’s just become unsustainable for us.”
“They’re still going to fall into that bucket, whether they’re with ICS or another provider,” Stephanie observes. “How is that going to make a difference?”
Danny explains that enrolling members in a plan like VNSNY CHOICE, one of the largest MLTCs in New York State, with tens of thousands of members averaging a much lower hourly rate of home care, the theory is that the high cost of members needing high-care can be better absorbed.
Continuity and Change
That word “absorbed” leads to a discussion about the fears Stephanie and many members have expressed of losing the unique community ICS represents to them. As Stephanie puts it, “ICS has a personal touch, and I would hate to lose that.”
Danny admits that no one knows what the next year will actually look like and that some change is inevitable. But he adds that the ICS Bronx and Brooklyn member centers will be open for business as usual, and member social programs will continue, more or less, as they have been, with many of the same instructors and offerings.
Danny explains how members with physical disabilities who move to ICS on April 1 will continue having their care managed by ICS staff through a special contract with VNSNY CHOICE, while those without those disabilities will have their care managed by VNS. All ICS members who continue to VNSNY CHOICE will receive a full year of guaranteed “continuity of care” (i.e., the same number of home care hours, same kinds, number and frequency of supplies and so on).
Members who opt not to switch to VNS will receive 120 days continuity of care and essentially “sever their ties to ICS,” according to Danny.
Health Home Basics
Another benefit of “riding it out” and being automatically enrolled in VNS, Danny says, is that only those members (as well as all other VNS members) will be able to join the new ICS Health Home if they meet other eligibility requirements.
“It’s not a physical place or a residence,” Danny explains, “It’s an organization that focuses on care coordination around the whole person….
“The Health Home…really fills in the gap where managed long-term care doesn’t cover. So our Health Home is going to focus on primary care, also specialty care, behavioral health… and also advocacy.”
Danny explains that Health Home members will be able to go to ICS for help if they need advocacy with their doctors or other providers, with their care plan, or if they ever need a fair hearing with the state.
What other benefits will Health Home members enjoy? Listen to the whole episode for the answer to this and a whole bunch of other questions!