DOH Preparing Another Round of Batch Disenrollments
Nursing home providers should have received a message from the Department of Health (DOH) with a Dear Administrator Letter (DAL) and several other attachments notifying them that the State is preparing to implement a second round of batch disenrollments of long-stay nursing home residents from partially capitated Managed Long Term Care (MLTC) plans. The first batch disenrollment was implemented on Aug. 1st and seems to have gone well, although there were a number of residents who seemed to fit the disenrollment criteria who were not disenrolled.
Unless he or she is working toward returning to the community or requests a fair hearing, a resident meeting the four criteria listed below will be transferred to Medicaid fee-for-service (FFS) on Nov. 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 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.
This additional “Batch Process” will disenroll the members who now meet the above criteria and were not included in the Aug. 1st disenrollment. It will be initiated and executed by the Department, and disenrolled members will be converted to Medicaid FFS for ongoing coverage of their long-term nursing home care, effective Nov. 1, 2020. The process will establish the required entries in the Principal Provider Subsystem in the Welfare Management System (WMS) to initiate Medicaid FFS coverage for these individuals and direct payment to the nursing home. The individual will subsequently appear on the nursing home’s monthly roster.
Members will recall that new long-stay nursing home residents are no longer required to enroll into MLTC and that enrollment in partially capitated MLTC plans is now limited to three months for nursing home residents after their designation as a LTNHS. 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. 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 was done in advance of the August batch disenrollment, DOH is requesting that nursing homes notify DOH of any LTNHS residents enrolled in a partially capitated MLTC plan who are actively working toward discharge as defined in the DAL. The Department requests that nursing homes use the template provided by DOH (available for download here) to list residents who have been designated LTNHS and who have an active discharge plan to transition to the community. The template includes the name of the nursing home, a contact person (name, telephone, and email), the transitioning resident’s name, Client Identification Number (CIN), date of LTNHS designation, and the name of his or her MLTC plan. DOH asks that homes complete and upload the template through the Health Commerce System (HCS) using the Secure Transfer utility (instructions here) to the MLTC Nursing Home shared mailbox no later than Sept. 21, 2020. Homes that have no residents to list on the template are asked to notify the Department via DOH.sm.MLTCNH@health.ny.gov that they have reviewed and do not have any members who meet the criteria.
DOH will use the same plan member notices that were used for the August cycle. The change in benefit notice is here; the disenrollment notice is here. The DAL is available here. Please let us know if you have observed any payment issues stemming from the August batch disenrollment process or have other concerns with the transition.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841