Important Managed Care and Nursing Home Transition Updates
During the past few days the Department of Health (DOH) has released the following important managed care updates:
1.) Most Recent Nursing Home Managed Care FAQs
The latest set of Department of Health FAQs on the nursing home managed care transition is now posted on our website and available by clicking here or going to the FAQ Resources link on our Managed Long Term Care webpage.
2.) Benchmark Letter
DOH has released an important letter that LeadingAge NY was instrumental in developing that more fully explains critical issues around the benchmark rates, NAMI collection and universal NH billing codes in detail. The letter is posted on the DOH web site and is available by clicking here. This is an important resource that all members should download and keep as a reference.
3.) Alternative Payment Deadline Extension
During yesterday’s Managed Care Policy and Planning Meeting and again today on the FIDA Plan Call DOH confirmed that the deadline for submitting FIDA plan alternative payment proposals has been extended from July 1 to August 15th. DOH will, however, accept and review proposals submitted earlier than the revised mid-August due date.
4.) Remaining Counties to go Mandatory
DOH has announced that for the remaining upstate counties mandatory Medicaid managed care coverage will be effective as of July 1 based on recent approvals received from the Centers for Medicare and Medicaid Services (CMS). The following counties are approved for transition in June: Essex, Chemung, Chautauqua, Hamilton, Schuyler, Seneca, and Yates. DOH will close the “Front Door” for those new to community-based long term care (CBLTC) services on June 19, 2015. As of June 22, 2015, new users in these counties will be referred to NY Medicaid Choice (Maximus) and will also go through the CFEEC process. As of July 1, mandatory coverage will be effective statewide and will include the last remaining areas of Alleghany, St. Lawrence, Jefferson, Lewis, Franklin and Clinton counties.
This is in line with the DOH timeline of beginning the mandatory enrollment of new nursing home admissions into managed care in the rest of state. DOH stated that there is not going to be a gradual roll out in these new counties, but they are instead implementing the mandatory managed care enrollment for both the remaining HCBS counties and all upstate counties for the NH benefit as of July 1.
DOH has noted a figure from Maximus of only approximately 120 new nursing home admissions enrolled in mandatory managed care in the NYC counties that transitioned on Feb. 1. They did not offer an explanation for the seemingly low number, but merely noted their surprise. This may be due to the fact that the majority of new nursing home admissions come in under Medicare Part A or Medicare HMO, as well as possible HRA processing delays.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827