State Agrees to Delay Nursing Home Transition to Managed Care
During the Nov. 25 meeting of the Nursing Home Transition Workgroup, DOH agreed to a two-month delay in the transition of the nursing home population and benefit into Medicaid managed care. LeadingAge New York and others had advocated for a delay to address several unresolved issues and give providers and plans more time to prepare.
Under DOH’s latest proposal, persons who are permanently placed and Medicaid-eligible in a nursing home before March 1, 2014 in the FIDA region (NYC, Long Island and Westchester) and Sept. 1, 2014 elsewhere 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). However, any individuals who are newly permanently placed and/or become Medicaid eligible after those dates 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.
LeadingAge NY and other workgroup members again urged the state to consider extending the two-year period during which managed care plans would have to pay nursing homes at least the FFS rate. DOH reiterated that they would review the situation after one year, and consider extending it further at that time.
DOH also discussed efforts underway with LeadingAge NY and other groups to seek permission from CMS to have the state or its designee take over collection of resident net available monthly income (NAMI), relieving facilities and plans of this responsibility. Until that occurs, plans and providers would have the flexibility to work out the responsible party for NAMI collection. There was also considerable discussion about payments would work if someone is ineligible due to transfer of assets (in this case the plan would pay the facility while the determination is pending and then recoup the funds if the person is found ineligible).
Contracting, billing issues and timeliness of payment were also discussed at length. DOH plans to convene a group representing plans and providers to work through these issues and develop training for the provider community. LeadingAge NY is already working on educational programming in this area.
Finally, DOH indicated that they are planning to discuss having a separate rate cell for MLTC plans for enrollees who are permanently placed in nursing homes. Consumers expressed reservations about the proposal and further discussions are planned.
DOH plans to develop a final draft of their policy paper on the nursing home transition, and present it to the workgroup in December. Please contact us if you would like a copy of LeadingAge NY’s comments on the version discussed yesterday.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866