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PT and the Greater Good

Dancing Faster and Faster

Published April 10, 2013 11:18 AM by Dean Metz
New York state has made remarkable changes to the way it's administering Medicaid. The Medicaid Redesign Team has enacted changes that will completely alter the current practices and expectations of both providers and patients.

As of May 1, all long-term home health programs will cease to exist and patients must enroll in a managed long-term care (MLTC) plan. As of July 1, all participating providers must use the Universal Assessment System (UAS) for assessing their members. Starting next year, all dual-eligibles (Medicare and Medicaid) must enroll in a combination Medicare/Medicaid Advantage plan under Fully Integrated Dual Access (FIDA). That means most people who just enrolled in an MLTC will have to switch plans in a year. All providers will work on a per-member/per-month risk-adjusted reimbursement. They will bear the full brunt of the risk of caring for the most vulnerable in the state's population.

This means I have 18,000 patients and thousands of clinicians who need to be trained on these changes, which are immense in their breadth. Furthermore, the rules and guidelines evolve hourly (daily is a luxury).

In the end, I believe the state will benefit from better care and resource management, the patients will benefit from better coordinated care, and taxpayers will benefit from reduced burden of disease and the costs associated with it.

Its getting there that's the tough part.

I know I promised a post about experience in the US health system as a consumer, but that will be next week. I still need to think it through.

1 comments

I keep a list of potential blog topics on my phone, all of which need more thought.  Sometimes it takes me a few months to finally figure out how I want to discuss it.  Can't wait to read your ideas.  

Lisa Mueller April 15, 2013 9:50 PM

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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