Nursing Home Transition to Managed Care Further Delayed
During the Feb. 24th meeting of the Nursing Home Transition Workgroup, the Department of Health (DOH) confirmed that CMS approval is still pending for the State’s plan to transition the nursing home population and benefit into Medicaid managed care. Pharmacy services, cash flow concerns and the agenda for a March 10th webinar for downstate plans and providers were also discussed.
CMS and DOH are still discussing various financial aspects of the State’s proposal to move the nursing home population and benefit into managed care. As a result, DOH is delaying the proposed transition dates by one month. Any adults who are newly permanently placed in a nursing home and/or become Medicaid eligible after April 1, 2014 in the FIDA region (NYC, Long Island and Westchester) and Oct. 1, 2014 elsewhere, would be required to enroll/remain in an MLTC plan (if dual eligible) or mainstream plan (if Medicaid-only eligible). The nursing home would then be paid by the plan directly for services to those residents. Any permanently placed Medicaid-eligible residents in a nursing home before those dates would remain in the fee-for-service program for the duration of their nursing home stay (unless they voluntarily enroll in Medicaid managed care or are passively enrolled in FIDA and do not opt out).
The group discussed how the nursing home pharmacy benefit would work under managed care. Mainstream Medicaid managed care already includes a drug benefit. Under the Department’s proposal, nursing homes that have arrangements with pharmacy providers will be permitted to continue those arrangements during the three-year rate transition period. For MLTC enrollees, Medicare Part D should be covering dual eligibles, while the non-duals should be billed to Medicaid fee-for-service. DOH is proposing to leave the pharmacy benefit “carved out” for the time being and seek to have it incorporated into the managed care benefit in the future. DOH will be adding a pharmacy section to its nursing home managed care transition policy paper for public input.
There was an extensive discussion on cash flow, with provider representatives expressing concern about “clean claims” and timeliness of payment from plans. DOH stressed the importance of plans and providers working together on billing formats and training, as well as submission of test claims. DOH is seeking input from LeadingAge New York and other associations on specific problems that providers and plans are having with claims submission and adjudication for nursing home services. Members that have experiences or examples to share are asked to contact Dan Heim at LeadingAge New York this week.
DOH is scheduling an in-person meeting/webinar on the nursing home transition to managed care for those managed care plans, nursing homes and consumer representatives located in NYC, Long Island or Westchester County on March 10th from 10:30 am to 1 p.m. The in-person meeting will be held at the DOH Offices, 4th floor, Conference Room 4 A/B, 90 Church Street, New York, NY. Because of space limitations, only one person from each nursing home or plan will be permitted to attend this meeting. The meeting will be webcast for those that are unable to attend in person. Tentative meeting topics include an overview of the transition, appeals and due process provisions, definition of clean claim and a question/answer forum. The Department will be sending out instructions to RSVP for the in-person meeting as well as to join the webinar as soon as they become available. LeadingAge New York strongly encourages members located in the FIDA region to hold this date/time and participate in the session.
DOH plans to post on their website a final version of their policy paper on the nursing home transition in the near future. Please contact us with any questions, concerns or comments in the meantime.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866