Nursing Homes: Preparation for Batch Disenrollment Requires Response by March 31st

The Department of Health (DOH) is gearing up to process the next round of batch disenrollments of long-stay nursing home residents from Partially Capitated Managed Long Term Care (MLTCP) plans effective June 1, 2023. This marks the ninth such batch disenrollment, the most recent one having occurred effective Feb. 1, 2023. Unless the individual is identified as working toward a 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 1^st:

1. Resident is enrolled in a MLTCP plan.
2. 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)).
3. Resident has been in a LTNHS for more than three months (LTNHS 3+).
4. Resident has been determined by the LDSS to be financially eligible for nursing home Medicaid coverage.

A Dear Administrator Letter (DAL) dated March 17^th that describes the process is available here. DOH indicates that it is working with MLTCP plans to identify current 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 that nursing homes use a template that was circulated with the notice and is available here 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 Fri., March 31^st. Instructions for using the secure transfer functionality of the Health Commerce System (HCS) to upload the file are available here.

Homes that do not have any members who fit the above criteria of an active discharge plan are asked to notify the Department via DOH.sm.MLTCNH@health.ny.gov that they have performed the review and do not have any residents who meet the criteria.

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.

Enrollment in MLTCP 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. A copy of the notice that the individual receives regarding disenrollment is here, while the notification from NY Medicaid Choice is here.

DOH is fielding questions at DOH.sm.MLTCNH@health.ny.gov, but please let us know as well if you encounter any problems with the process.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841