Tougher Tack on Home Care Third Party Liability (TPL)

LeadingAge NY members are reporting that they have received unusually burdensome requests for records in relation to the New York State Office of Medicaid Inspector General's (OMIG's) third party liability recovery efforts. The OMIG has contracted with the University of Massachusetts Medical School (UMMS) to administer the Medicare Home Health Appeals Initiative. We have spoken with staff both at UMMS and OMIG about our concerns with the volume of claims requested, especially in light of the expansion of mandatory managed care enrollment, the reductions in Long Term Home Health Care Programs, and the limited availability of staff to respond to the document requests.  This mandate is not new - we have submitted letters to the Centers for Medicare and Medicaid Services (CMS) as far back as 2009 and asked for a permanent solution. However, the timing and volume of the latest requests are particularly troublesome.

LeadingAge NY continues to advocate on this issue and we will keep members abreast of any developments.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871