More Nursing Home Residents Revert to FFS
The Department of Health (DOH) implemented a second round of batch disenrollments of long-stay nursing home residents from partially capitated Managed Long Term Care (MLTC) plans on Nov. 1st. Unless they were working toward returning to the community or requested a fair hearing, residents meeting the four criteria listed below were transferred to Medicaid fee-for-service (FFS) on Nov. 1st:
- Resident was enrolled in a partially capitated MLTC plan;
- Resident’s status was 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 had been in a LTNHS for more than three months (LTNHS 3+); and
- Resident had been determined by the LDSS to be financially eligible for nursing home Medicaid coverage.
This additional “Batch Process” also covered individuals who met the above criteria but were not included in the Aug. 1st disenrollment.
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.
DOH is using 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 Sept. 14th Dear Administrator Letter (DAL) to nursing homes outlining the process is available here. We remind members that it is important to track Net Available Monthly Income (NAMI) payments during these transitions to ensure that they are paid to the appropriate entity. Please let us know if you encounter problems with the transition.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841