Possible Change in Nursing Home Managed Care Transition?

For nursing homes in the Fully Integrated Duals Advantage (FIDA) demonstration region, the Department of Health (DOH) has indicated the possibility that nursing home residents could be transitioned directly from fee-for-service into FIDA plans, without the proposed interim transition into Medicaid managed care.  This potential further delay - which is not yet official - comes on the heels of association advocacy with DOH and the Centers for Medicare and Medicaid Services (CMS) to address several questions and concerns about the proposed transition of the nursing home benefit and population into managed care.  

As previously communicated, LeadingAge New York and its association colleagues developed a matrix of questions and concerns on cash flow, other payment issues, enrollment/eligibility/coverage and network/contracting. At CMS's request, we shared an updated version of the document (please click here) with them which includes DOH's responses and our reactions to DOH's answers.  

Currently, DOH has slated July 1 as the target date to require new Medicaid nursing home residents to enroll or remain in either managed long term care (MLTC) plans (for duals) or mainstream managed care plans (for Medicaid only) in the FIDA region.  Jan. 1, 2015 is the date set for all mandatory MLTC enrollees in NYC, Long Island and Westchester County, including nursing home residents, to be passively enrolled in FIDA plans .  As previously communicated, the current Medicaid managed care transition date of July 1 for nursing home residents had been set for April 1, 2014 and has been postponed multiple times pending receipt of required waiver approvals from CMS.  It is uncertain that CMS approval will be granted in time to allow for the July 1 transition date.  In the event that the Medicaid managed care transition date continues to be pushed closer to Jan. 1, DOH may consider foregoing a separate MLTC transition in favor of transition to FIDA.

For the rest of State (the non-FIDA region), the proposed Medicaid managed care transition date for new nursing home placements follows six months later, currently Jan. 1, 2015.  The impact of a possible direct to FIDA transition on the rest of the State is unclear.

We will continue to advocate for resolution of outstanding questions and concerns prior to implementation, and to keep members informed of the latest developments.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827.