2015 HIV SNP Enrollment

HIV Special Needs Plans (HIV SNPs) are a vehicle for providing health care to HIV infected Medicaid patients in New York City. For more information contact New York Medicaid Choice at 1-800-505-5678 or the following HIV SNPs:

MetroPlus Partnership in Care Plan 1-800-303-9626

VNSNY CHOICE SelectHealth 1-866-469-7774

Amida Care 1-800-556-0689

HIV Special Needs Plans have been operational since 2003. See this post for A History of New York HIV Special Needs Plans. This page contains the current enrollment and the history of enrollment for the 3 active Plans. The entire HIV Special Needs Plan Model Contract is available for download here. The statistics below have been extracted from the NYSDOH Monthly Medicaid Managed Care Enrollment Report. Download the report Dec 2015 Stats

2015 Stats Infographic

2015 Stats Infographic

NY State of Health Exchange Excludes Medicaid HIV Special Needs Plans

01/12/16 Update:  NYSDOH to add HIV Special Needs Plans to the Exchange January 15, 2016.  More information here: https://nystateofhealth.ny.gov

This post is outdated.

Newly enrolled Medicaid recipients residing in New York City must enroll in a Medicaid Managed Care Plan.   To do so online they visit the NY State of Health Exchange.  They then choose from a list of available Plans to join. However, if they are HIV positive and they want to enroll in 1 of 3 unique and specialized Medicaid HIV Special Needs Plans (HIV SNPs) in existence since 2003 and currently serving over 15,000 members, that option is not currently (May 2015) available to them and has not been since the Exchange went live in 2013.  The HIV SNPs are not listed.  Eligible Medicaid recipients can only  join an existing Mainstream Medicaid Managed Care Plan through the Exchange. Once joining a Mainstream Medicaid Plan they cannot transfer to an HIV SNP.  This restriction may also apply to former members of an HIV SNP who were disenrolled due to loss of Medicaid coverage, but upon re-enrollment in Medicaid cannot return to the HIV SNP in which they were previously enrolled.

The State has developed a manual work around but it is not often used because it is cumbersome, time consuming and requires recipients to request provider assistance.

Although the New York State Department of Health has been aware of this problem since the launch of the Exchange, this online enrollment option still remains unavailable (October 2015).

Meanwhile aggregate enrollment in the HIV SNPs continues to decline from its peak membership of 17,072 in 2012 to 14,719 as of September 2015. The HIV SNPs have urged the State to remedy the situation and recently Governor Cuomo’s End the Epidemic Task Force also recommended a resolution in the Task Force Blueprint recommendation BP10 on page 22.  The State recently met with the HIV SNPs and some  steps towards implementation have been taken but no completion date has been established.

Follow this post for additional updates.

12/31/2015 – By mid January 2016 the HIV SNPs are expected to be on the Exchange.   

HIV SNP Enrollment Work Around 2015

01/12/16 Update: NYSDOH to add HIV Special Needs Plans to the Exchange January 15, 2016.  Learn more here: https://nystateofhealth.ny.gov

This post is outdated.

 

This Work Around provided by the NYSDOH AIDS Institue and shared with Designated AIDS Center Medical and Administrative Directors. It is useful to all NYC HIV Primary Care Providers.

Some of your patients may now qualify for Medicaid and be asked to choose a Managed Care plan. If they enrolled through the Exchange and live in NYC, there has been no option to choose an HIV SNP.

DOH has devised a workaround process to allow enrollment in a SNP  The process is not ideal and we suspect requires some help from available navigators and assistors.  Please share the referral process outlined below with any support staff who may have been helping with Medicaid any enrollment through the Exchange.

Making it work-HIV Special Needs Plans not a Medicaid plan option on NYSoH Exchange
NYSDOH has outlined a workaround process to allow eligible HIV+ consumers in NYC who qualify for Medicaid to enroll in an HIV SNP.  If assisting patients with Medicaid enrollment please review process below.  You may want to refer patients to any of the designated navigator agencies you use.

The referral process outline:

·         Medicaid eligible SoH consumer contacts the SoH consumer call center ( Toll free 1–855 -355-5777) and identifies their need to enroll in a SNP.  Consumers who want to change from a mainstream plan to SNP must follow the same process.  Consumer may choose to designate a representative to assist with call center contact.

·         SoH Consumer counselor informs consumer of SNP program scope, if consumer indicates the wish to enroll, the counselor creates a system referral.Consumer can identify which SNP during this call.  Consumers will not be required to share other confidential information.  Counselor will ask for alternate phone number to speed outreach by Medicaid Choice.

·         In 5-7 days, the consumer’s case is passed to DOH Coverage and Enrollment staff to have the SoH case closed and a LDSS/WMS case opened.  DOH Coverage and Enrollment and NY Medicaid Choice have identified dedicated staff to this process.

·         At the same time, DOH staff informs New York Medicaid Choice of impending consumer transfer to WMS system for need of SNP enrollment.Someone from NYMC will call the consumer within 5-7 days to help select the right SNP and to assist with enrollment, or to confirm the plan selected for enrollment and to answer any questions the consumer may have.

·         Upon receipt of prospective SNP enrollee, NY Medicaid Choice conducts phone outreach to consumer to educate and confirm plan selection.  The plan selection is pended in Medicaid Choice system for WMS case opening.  During outreach consumer may choose to designate a representative to assist with phone enrollment process.

·         As with all managed care enrollments, the effective date will be based on the enrollment pulldown schedule.  Entire process may take 30-60 days.

·         Newly enrolled SNP member will receive confirmation notice of enrollment and effective date from Medicaid Choice.  Plan ID card and member packet is sent to consumer within 14 days of effective date of enrollment.

AIDS Institute, Office of Medicaid Policy and Programs

Glossary of Terms in Healthcare Reform

Extracted from a presentation  delivered  by Courtney Burke, Deputy Secretary for Health, New York State at the New York Academy of Medicine dated April 30, 2015;

Health Care Reform in New York State Fitting the Pieces Together toward the Triple Aim:  Better Care, Lower Costs, and Improved Health for All

Terms

History of New York HIV Special Needs Plans

The following link is to a video presentation to doctoral students at New York Medical College March 2013 which provides a historical overview of HIV Special Needs Plans in New York. 

Designing a Medicaid HIV Special Needs Plan in New York
Eli Camhi, LMSW, Executive Director
VNSNY CHOICE SelectHealth

In 2003 New York State Department of Health approved the go live of fully capitated comprehensive Medicaid Managed Care Plans called HIV Special Needs Plans (HIV SNPs). Designed to meet the needs of the HIV community, these Plans are offered as an alternative to regular Medicaid Managed Care Plans. In addition to standard NYSDOH Medicaid Benefits HIV SNPs have the following distinguishing features: 
 
Membership is restricted to Medicaid eligible HIV Positive Adults and their children (up to the age of 21 regardless of HIV status) residing in New York City. As of  March 2014, uninfected homeless adults could also join.
 
Members have access to full Medicaid benefits: Inpatient care, outpatient care, pharmacy, dental, vision, laboratory, durable medical equipment, behavioral health services, home care, specialty care, primary care and other additional Medicaid benefits.  
 
All HIV positive members must choose an HIV Specialist PCP as their primary care provider. No more than 350 members can be assigned to a single full time HIV PCP. HIV SNPs must credential their HIV PCPs each year to confirm that they have completed a minimum of 10 hours of continuing medical education in the management of HIV antiretroviral therapy.
 
HIV SNPs also offer care coordination services to members.
 
There are 3 HIV SNPs operating in New York State and located in New York City. As of February 2015, they collectively provide services to approximatley 15,232 members residing in New York City.  Current hivsnp enrollment statistics. The three hivsnp are:
 
Amida Care
MetroPlus
VNSNY CHOICE SelectHealth

For current information about HIV SNPs and related topics you are invited to join the free hivsnp discussion group. 

—————— 

Information about the hivsnp discussion group

hivsnp discussion group
hivsnp message archive
 
The HIV Special Needs Plan (hivsnp) moderated discussion group provides a forum for ideas, comments, links, job announcements, event announcements and news about disease management approaches to population health and New York State Medicaid HIV Special Needs Plans in particular.  
 
Common topics from recent posts include AIDS, Adherence, Accountable Care Organizations, Care Management, CDC, Cost of Care, Hepatitis C, Pay for Performance, Patients, Medicaid, Medicare, New York Providers, Patients, Pharmacy, Population Health, Triple Aim, Viral Load.
 
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2014 SNP Enrollment

HIV Special Needs Plans (HIV SNPs) are a vehicle for providing health care to HIV infected Medicaid patients in New York City.  For more information contact New York Medicaid Choice at 1-800-505-5678 or the following HIV SNPs:

MetroPlus Partnership in Care Plan 1-800-303-9626

VNSNY CHOICE SelectHealth 1-866-469-7774

Amida Care 1-800-556-0689

HIV Special Needs Plans have been operational since 2003.  This page contains the current enrollment and the history of enrollment for the 3 active Plans. The entire HIV Special Needs Plan Model Contract is available for download here.  The statistics below have been extracted from the NYSDOH Monthly Medicaid Managed Care Enrollment Report.

 

1214 Current

1214 YTD

 

The Moral Test

Don Berwick’s video describes his understanding of  The Moral Test.  As governor of Massachusetts he intends to make the State a beacon for the nation in fulfilling the Moral Test.

“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”

Remarks at the dedication of the Hubert H. Humphrey Building, November 1, 1977, Congressional Record, November 4, 1977, vol 123, p. 37287.
Wikiquote: http://en.wikiquote.org/wiki/Hubert_Humphrey

Don’s dedication to improving the health of our nation has been a significant influence on my work so I am supporting his candidacy.

Contact me directly if you would like to learn more how you can help with his campaign.

Eli Camhi
ecamhi@generes.com
www.linkedin.com/in/elicamhi/

 

 

2013 SNP Enrollment

HIV Special Needs Plans (HIV SNPs) are a vehicle for providing health care to HIV infected Medicaid patients in New York City.  For more information contact New York Medicaid Choice at 1-800-505-5678 or the following HIV SNPs:

MetroPlus Partnership in Care Plan 1-800-303-9626

VNSNY CHOICE SelectHealth 1-866-469-7774

Amida Care 1-800-556-0689

HIV Special Needs Plans have been operational since 2003.  This page contains the current enrollment and the history of enrollment for the 3 active Plans.

The entire HIV Special Needs Plan Model Contract is available for download here.  The statistics below have been extracted from the NYSDOH Monthly Medicaid Managed Care Enrollment Report.

Dec 2013

YTD 2013

 

Don Berwick

My friend Don Berwick called me the other day and asked for my help. Don is running for Governor of Massachusetts and needs financial support for the campaign. Campaign contributions are limited to $500 per year per individual. I reached this limit earlier this year and now I am asking you to make the same contribution. Contact me if you would like to help with Don’s campaign.

I gave without hesitation because over the past 15 years Don’s dedication to improving the health of our nation has been a significant influence on my work.

Eli Camhi

hivsnp posts May 11, 2013

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