DOH Prepares February 2023 Batch Disenrollment of Nursing Home Residents from MLTC
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 on Feb. 1, 2023. The most recent batch disenrollment was effective Oct. 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 MLTCP 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.
A Dear Administrator Letter (DAL) dated Nov. 18th and circulated on Nov. 21st that describes the process is available here. DOH indicates that it is working closely with MLTC 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., Dec. 2, 2022.
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.
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