Nursing Home Managed Care Transition Questioned

The state is seeking to transition permanently-placed Medicaid-only nursing home residents (i.e., those eligible for Medicaid, but NOT Medicare) throughout the state to Medicaid managed care plans in October of this year. An estimated 6,000 residents spread across over 450 nursing homes throughout the state would be affected, with larger concentrations in facilities with specialty beds (e.g., AIDS, ventilator, TBI, etc.).

Several questions and issues were raised during the work group meeting relative to how the managed care plans would be paid for these individuals, how nursing homes would be paid by the plans and how the issues of capital reimbursement, universal settlement, quality pool and case-mix would be addressed. DOH modified its proposal to require the managed care plans to pay the Medicaid fee-for-service rate to facilities for these residents for two years, instead of one year.

Bigger questions were raised by both managed care and nursing home representatives about whether Medicaid-only residents should be transitioned into managed care prior to the 2014 implementation of the FIDA demonstration, which would now include dually eligible (i.e., Medicare and Medicaid) nursing home residents in NYC, Long Island and Westchester County. DOH officials said they would consider this question.

LeadingAge NY’s Nursing Home Managed Care Work Group is meeting again later this week to discuss these issues and make recommendations on future strategy. The next meeting of the DOH work group is scheduled for July 23 in Albany, during which subgroups would consider fiscal, network, eligibility/enrollment and access/quality issues.

Contact: Dan Heim dheim@leadingageny.org, 518-867-8866