Independence Care Systems (ICS) to Transition to VNSNY Choice

Carl Pucci and Allison Gold in Managed Care

On Wednesday, March 5, NYSHFA/NSYCAL was briefed by the Department of Health on the shut down of Independence Care System (ICS), a Manhattan-based managed long-term care (MLTC) plan that specializes in treating chronically ill and disabled individuals. ICS has been struggling financially and will no longer participate as a health plan in the New York State MLTC program as of March 31, 2019. In collaboration with DOH, ICS has entered into an arrangement with VNSNY Choice, another MLTC, to service ICS enrollees effective April 1, 2019.

ICS Liabilities

DOH indicated that ICS’ total projected liabilities to providers is approximately $131 million, which represents 75 percent of estimated total liabilities. This figure was calculated using (1) the known liabilities through March 1, 2019 and (2) the expected utilization estimates for the month of March based on past utilization and authorizations. About 300 providers will receive notices within the next week or so (ICS and VNS hopes to mail out on March 8) which will include the amount to be paid to that provider based on the calculation method above. Providers wishing to accept the 75 percent payment will need to sign a release with ICS and VNSNY Choice that the provider agrees to:

  • Enter into an agreement to a release ICS/VNSNY Choice from future liabilities by accepting the 75% payment; and
  • Agree to participate or continue to participate in VNSNY Choice’s network for three years or enter into a specialty agreement for ICS members.

Liability payments will be distributed to providers using an “Enhanced Provider Network Reimbursement,” that will be part of VNSNY Choice’s premium rate to be passed on to participating providers. Stated another way, the monthly capitated rate for VNSNY Choice will be reflective of VNSNY patients plus the transitioning ICS members and the payments representing 75% of liabilities paid out quarterly over three years. No lump sum or cash advance options are available for these providers. Providers will need to decide if they wish to accept the payment and enter into the networking agreement by the end of March 2019.

Discussions on liabilities to providers with no current ICS member also took place. The Department and ICS indicated there are about 100 providers that fall into this category with liabilities totaling roughly $3.5 million, but it is unknown at this time how and when those claims will be addressed. DOH does not anticipate the need to sign a release for this provider group.

Transition Rights for Patients

DOH indicated there are transition rights in place for ICS members. ICS members who move to VNSNY Choice will receive the services ICS provided for one year, while those who join a plan other than VNSNY Choice will have the standard 120-day continuity of care provided for in the State's MLTC Policy 17.02. If an individual was a member of ICS in January 2019 and transferred to a different plan for February 2019 or later, the individual has transition rights.

NYSHFA/NYSCAL will keep members updated as this transition plan unfolds.

NYSHFA CONTACTS:

Allison Gold, Esq.
Director of Policy & Reimbursement
518-462-4800 x25

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36