Nursing Home Transition Managed Care Webinar and New June 1 Deadline!
The Department of Health (DOH) has just announced that the new date for the transition of nursing home residents into managed care plans is slated to start June 1, 2014 (previously April 1) for new permanent placements in the downstate area. LeadingAge NY is seeking clarification on the corresponding deadline of Oct. 1, 2014 for new permanent placements in the rest of the State. Finalizing these start dates is still contingent upon federal approval of the DOH transition plan, and is the reason for this most recent delay.
Even as these transition deadlines loom, several issues and concerns remain to be resolved from the perspective of both our LeadingAge NY nursing home and managed care members. To tackle these issues, our nursing home and managed care members are working together on our Nursing Home Managed Care work group.
This group has been active over the past few months, providing critical insights and guidance to LeadingAge NY as we continue to advocate on behalf of our members during this transition period. LeadingAge NY is uniquely positioned to provide both the provider and plan perspectives and advocate for solutions that build upon a strong partnership among our members.
While the recent DOH meeting and webinar on the transition provided important guidance (see DOH reference materials below and note that these materials may still reference the April 1 start date), some of the topic areas that remain unresolved include: NAMI payments, the personal needs allowance, co-insurance and cost sharing, authorizations and Medicaid processing. With the support of our members, LeadingAge NY continues its advocacy on these issues and premium adequacy and will also continue to update members on all the latest developments.
The nursing home managed care transition webinar, hosted by DOH on March 20, repeated the presentation given at a March 10 meeting that was to be webcast, but was not due to technical problems. The March 20 webinar was not recorded. The presenters closely followed the information contained in the following slides:
The formal presentation was followed by a Question and Answer (Q&A) period that included the following clarifications:
Q1. How often will Managed Long Term Care (MLTC) plans reauthorize service?
A. Reassessments will be required every six months or if a significant change in condition of the resident occurs. This is the same as the current requirement.
Q2. Who will be the enrollment broker? What authority gives them access to the nursing home? Will managed care plans be disciplined if they market directly to residents?
A. Medicaid Choice (Maximus) will be the enrollment broker. Nothing authorizes them to access a nursing home, but the state hopes nursing homes and Maximus will work together cooperatively. Once Maximus is notified through the Medicaid eligibility system of a Medicaid nursing home placement, they will reach out to the nursing home to arrange an on-site visit or call with the resident to review enrollment requirements and choices. The state will discipline plans if they market directly to nursing home residents.
Q3. If a permanent nursing home resident in FFS Medicaid (i.e., permanent placement prior to the date of mandatory managed care) is discharged to a hospital because they do not have bed hold, will they need to enroll into a managed care plan when they return to the nursing home?
A. The DOH initial response is yes, although further clarification may be provided.
Q4. Is there an enrollment process for individuals with mental impairment?
A. DOH expects to handle such issues on a case by case basis working with designated representatives of impaired residents.
Q5. What can providers do if they encounter problems or delays in getting authorization for service or in the appeals process?
A. Providers encountering such issues should call the DOH hotline. For MLTC call 1-866-712-7197; for mainstream plans call 1-800-206-8125.
Q6. Who does the assessment (UAS)?
A. The UAS is done by the plan or its contractor. The process is the same as for community MLTC enrollees, but done in the nursing home setting.
Q7. Who is responsible for assisting the resident in the institutional Medicaid eligibility process?
A. It is in the interests of both the plan and provider to work together. The Eligibility and Enrollment section of the slides (starting on p. 14) outlines the process.
Q8. What is carved in and what is carved out of the NH rate?
A. DOH has posted information on the services included in each home’s Medicaid rate here.
Due to the many questions concerning the enrollment process, DOH promised to explore the possibility of doing a targeted presentation on the enrollment and eligibility determination process. DOH also envisions doing another webinar as the upstate mandatory date approaches. We will let members know as soon as these are scheduled. In the meantime, please contact us if you have questions.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8383 ext. 128 or Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827