DOH Prepares Next Batch Disenrollment of Nursing Home Residents from MLTC
The Department of Health (DOH) will process the next round of batch disenrollments of long-stay nursing home residents from Partially Capitated Managed Long Term Care (MLTC) plans on June 1, 2022. The previous batch disenrollment was done on Feb. 1, 2022. Unless the individual intends to return to the community or requests a fair hearing, residents meeting the four criteria listed below will be transferred to Medicaid fee-for-service (FFS) effective June 1st:
- Resident is enrolled in a Partially Capitated MLTC plan;
- Resident’s status is identified as a long-term nursing home stay (LTNHS) (i.e., LDSS-3559 or equivalent provided to resident and submitted to local department of social services (LDSS));
- Resident has been in a LTNHS for more than three months (LTNHS 3+); and
- Resident has been determined by the LDSS to be financially eligible for nursing home Medicaid coverage.
The March 18th Dear Administrator Letter (DAL) outlining the process is available here, and the text of the email notifying nursing homes is copied below:
The purpose of the attached letter is to notify nursing homes of the intention of the Department of Health to conduct another “Batch Process” disenrollment to continue implementation of the change in coverage of the long term nursing home care benefit in the Medicaid Managed Long Term Care Partial Capitation plan (MLTCP plan). This “Batch Process” disenrollment will be effective June 1, 2022.
To implement this additional batch disenrollment, and as further described in the “Implementation and Information Required from Nursing Homes” section of the attached letter, the Department of Health (the Department) is requesting nursing homes transmit to the Department a list of all residents who are designated as long term nursing home stay (LTNHS), are enrolled in an MLTCP Plan, and have an active discharge plan to transition to the community.
The Department is now working closely with MLTCP plans to identify current MLTCP plan enrollees who are designated as LTNHS, have met or exceeded the three-month benefit period, and were not disenrolled in prior batch processes. To ensure that members who may be in the process of transitioning to the community are not disenrolled from their MLTCP plan, the Department is requesting nursing homes use the attached template to provide a list of their nursing home residents who have been designated LTNHS and who have an active discharge plan to transition to the community no later than Friday April 1, 2022. We appreciate your assistance. Questions may be directed to DOH.sm.MLTCNH@health.ny.gov.
The change in the long-term nursing home care benefit has no impact on rehabilitative, short-term, or temporary nursing home residents and does not impact Program of All-Inclusive Care for the Elderly (PACE) participants, Medicaid Advantage Plus (MAP) members, or mainstream Medicaid managed care enrollees.
As always, DOH is requesting that plans and providers assist in identifying residents who meet the disenrollment criteria but who have an active discharge plan to transition to the community. Such residents should not be disenrolled. An active discharge plan means that the resident’s care plan has current goals to make specific arrangements for discharge and/or staff are taking active steps to accomplish discharge.
New long-stay nursing home residents are no longer required to enroll in MLTC, and enrollment in Partially Capitated MLTC plans is limited to three months for nursing home residents after their designation as being in a LTNHS unless the individual requests a hearing. The three-month benefit period begins on the first day of the month following the month of the effective date of the LTNHS designation documented by the nursing home, in conjunction with authorization by the MLTC plan, on the LDSS-3559, “Residential Health Care Facility Report of Medicaid Recipient Admission/Discharge/Readmission/Change in Status,” or an approved local equivalent.
If you encounter problems with the process, please let us know.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841