powered by LeadingAge New York

DOH Asks MLTC Plans to Update List of Members Residing in Nursing Homes

The Department of Health (DOH) is working toward implementing the three-month nursing home benefit limitation for individuals who are enrolled in partially capitated Managed Long Term Care (MLTC) plans and are designated as long-term nursing home stay (LTNHS). Current enrollees that have been in a LTNHS for more than three months (LTNHS 3+) will now be disenrolled in all parts of the state effective May 1, 2020. DOH is requesting that plans that submitted a list of LTNHS 3+ members previously review the list and identify any members that are now deceased, have returned to the community, or are no longer designated as LTNHS. Plans that have not yet submitted lists are asked to verify the Excel file provided by DOH listing all members with active nursing home Recipient Restriction/Exception (RR/E) codes (N1-N9), supply the requested information, and identify the appropriate nursing home residency status for each member listed. DOH requests that plans submit responses, both updates and initial files, by March 9th to DOH.sm.MLTCNH@health.ny.gov.

Last Friday, the Department confirmed to plan associations that batch disenrollment of members who have met the three-month criteria will occur on May 1st statewide and outlined the process for future, plan-initiated disenrollments of members who are designated LTNHS.

In a nutshell, DOH envisions the following process:

  1. A nursing home will notify the plan within 48 hours of a member’s designation as LTNHS.
  2. The plan will send the appropriate notice to the member within five days of receiving notice from the nursing home.
  3. Two months after the designation, the plan will send a notice of intent to disenroll to the member and submit a disenrollment package to Maximus.
  4. Maximus will process the disenrollment.
  5. If at any time before disenrollment the member requests to remain in the plan, the disenrollment will be suspended, and the plan will be required to complete a resident assessment within 30 days.

DOH is finalizing several notice letter templates that were circulated for review and intends to discuss the process, timing, and notice requirements at the March monthly plan meeting.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841