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CFEEC Policy for Nursing Home Residents

On Nov. 24th, the Department of Health (DOH) has released Managed Long Term Care (MLTC) Policy 15.06: Nursing Home Transition - Conflict-Free Evaluation and Enrollment Center (CFEEC) and Uniform Assessment System (UAS) Requirements.

This is a wide ranging policy statement that both nursing home and managed care organizations should review and maintain for ready reference.  The main points covered in the document include:

1.       Clarification of the role of the CFEEC (i.e., Maximus/Medicaid Choice) in assessing Medicaid-covered nursing home residents seeking discharge back to the community; and

2.       A reminder that as of Oct. 1, 2015 permanently placed nursing home residents may now voluntarily enroll in Medicaid managed care and they may do so without the need to go through the CFEEC.

Nursing home residents that are not enrolled in a Managed Long Term Care Plan (MLTC) and approaching discharge with access to community based Medicaid services must be referred to the CFEEC to determine clinical Medicaid eligibility.  This will require the completion of a UAS-NY in accordance with MLTC Policy 13.09

Effective Oct. 1, 2015, permanently placed nursing home that voluntarily enroll in MLTC and then consider returning to the community may continue services through their established plan.  In this case, however, referral to the CFEEC is not required.  The MLTC, nursing home discharge staff and the individual’s physician will develop the plan of care for the transition to the community. 

For additional details, please refer to the DOH policy.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827