LeadingAge NY, Other Associations Weigh In on Nursing Home Managed Care
As the State’s proposed launch date for transition of nursing home services to Medicaid managed care approaches, LeadingAge NY has partnered with other associations to identify and make recommendations on several unresolved issues with the transition.
In a joint association letter dated May 16, LeadingAge NY and its association partners urged the Department of Health (DOH) to ensure that premium payments to Medicaid managed care plans properly reflect varying payment levels for contracted and out-of-network nursing home services. At issue is DOH's plan to pay premiums to managed care plans reflecting regional average nursing home rates, whereas the plans will be required to pay nursing homes their "benchmark" (i.e., fee-for-service) rates for the first three years after transition. Our concern is that this would create a financial disincentive for managed care plans to contract with nursing homes that have higher than average Medicaid rates.
Late last week, LeadingAge NY and its association colleagues also presented DOH with a document detailing a series of unresolved issues relative to the transition of the nursing home benefit and population into Medicaid managed care. The issues fall into four major categories: (1) cash flow; (2) other payment areas; (3) enrollment/eligibility/coverage; and (4) network/contracting. For most issues that were raised, we presented recommended resolutions. LeadingAge NY received extensive input on these issues from its Nursing Home Managed Care Workgroup, as well as through educational sessions and other forums we have conducted to prepare member organizations for this major transition.
DOH officials have indicated that they are preparing responses to the issues we have raised, and further discussions are planned on how nursing home costs will be factored into the premiums paid to Medicaid managed care plans. As this issue of Intelligence goes to press, the State has yet to receive approval from the Centers for Medicare and Medicaid Services for its plan to transition the nursing home population and benefit into Medicaid managed care. We expect an announcement any day now on whether the planned June 1, 2014 launch date for this transition in the FIDA region (NYC, Long Island and Westchester) will be postponed and, if so, the proposed rescheduled date. Other areas of the State are planned to begin transition six months following the FIDA region effective date.
In an effort to further assist its members, LeadingAge NY is currently working on a Frequently Asked Questions document about the nursing home managed care transition. Please continue to forward any questions you have to us in the meantime.
Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866