Webinar, More Information on Nursing Home Managed Care Transition

During the Jan. 16 meeting of the Nursing Home Transition Workgroup in Albany, Department of Health (DOH) officials confirmed that the federal government has given the State written approval to begin transitioning the nursing home population and benefit into Medicaid managed care on Sun., Feb. 1, 2015. Meanwhile, DOH confirmed its plans to host a webinar on this transition on Thurs., Jan. 22 at 10 am.

As previously noted, the transition will occur in three phases: (1) New York City boroughs beginning Feb. 1, 2015; (2) Nassau, Suffolk and Westchester counties beginning April 1, 2015; and (3) remaining counties beginning July 1, 2015. Any Medicaid-eligible individual who is permanently placed in a nursing home after each of these respective dates will be required to enroll or remain in a managed long term care plan (if dually eligible) or mainstream managed care plan (if Medicaid-only eligible). Beginning Oct.1, 2015, any Medicaid eligible nursing home resident not otherwise required to enroll in a managed care plan will be able to enroll voluntarily.

DOH’s Jan. 22 webinar will review the major elements and timeframes of the nursing home transition. All member nursing homes and Medicaid managed care plan sponsors are encouraged to participate. To register for the webinar, “Nursing Home Transition into Managed Care,” click here. For those unable to participate, DOH plans to make a recording of the event available.

DOH will also be publishing a list of Frequently Asked Questions (FAQs) on the transition. LeadingAge New York has drafted an extensive list of FAQs and furnished it to DOH for inclusion in their materials. Among the clarifications offered during the Jan. 16 meeting were the following:

• The Centers for Medicare & Medicaid Services has not yet issued the Standard Terms and Conditions governing the transition to the State; they are expected soon.
• There is no timetable yet for transitioning the under age 21 Medicaid population in nursing homes to mandatory managed care.
• Premium payments to managed care plans will include a deduction for Net Available Monthly Income (NAMI), meaning that the plans will have primary responsibility for collecting NAMI unless they negotiate with nursing homes to retain that responsibility.
• At this point, Medicaid beneficiaries who will be mandated to enroll in managed care as the result of permanent nursing home placement will not be required to go through the conflict free evaluation process using the UAS-NY.

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