MLTC Plans That Do Not Offer a DSNP Product Directed to Begin Transition Process

The Department of Health (DOH) released guidance last week providing a notice process and transition timeline for Managed Long Term Care (MLTC) plans that do not have a Dual-Eligible Special Needs Plan (DSNP). The DOH guidance arises out of budget legislation that imposes performance standards on MLTC plans, including a standard that they offer a DSNP by Jan. 1, 2024. The goal of the initiative is to reduce the number of partially capitated MLTC plans (MLTCPs), while ensuring that the remaining plans offer integrated coverage for beneficiaries eligible for both Medicaid and Medicare. The Department is acting swiftly to phase out MLTCPs that do not offer a companion DSNP.

The guidance establishes a timeline and process for transitioning enrollees from MLTCPs that do not offer DSNPs to other MLTC plans. MLTC plans that do not have a DSNP must submit a Transition Notice to DOH by June 30, 2023. The Transition Notice must be sent to the plan's manager in the DOH Bureau of MLTC (BMLTC) here. The Transition Notice must state whether the MLTCP will withdraw from the Partial Capitation program or engage in a merger or acquisition transaction with a certified Article 4403-f MLTC plan that satisfies the DSNP requirement. It is unclear how plans that have a DSNP application pending should proceed. Questions on the Transition Notice should be submitted to the DOH MLTC email account here and copied to the assigned BMLTC plan manager.

Plans that do not meet the DSNP performance standard are also directed to comply with DOH MLTC Policy 17.02 governing the transition of beneficiaries and submit an affirmation certifying their intent to comply. Under MLTC Policy 17.02, beneficiaries cannot be transitioned to a new plan until DOH approves the closure or merger of the existing plan and the plan's notices to beneficiaries. In the event of a closure, beneficiaries will be directed to contact NY Medicaid Choice (NYMC), and NYMC will process the transfer to the new plan of choice via a 'warm' transfer process. The plan that is closing must provide the new plan with detailed information on the beneficiary's plan of care and network provider relationships. In the event of a merger or acquisition, beneficiaries will be provided with information on plan choice and may elect to transfer to any other MLTC plan, within a 60-day selection period.

The new plan must accept the transfer enrollment of all beneficiaries who select or are auto-assigned to the plan. The new plan must also continue to provide services under the beneficiary's existing plan of care, and utilize existing providers, for the earlier of the following: (i) 120 days after enrollment; or (ii) until the new plan has conducted an assessment and the beneficiary has agreed to the new plan of care.

Plans that have an active DSNP (and are in compliance with the performance standard) must, no later than June 30, 2023, reply to DOH indicating their compliance and include the H contract number for their DSNP and their Medicare Advantage Bid Filing. This information must be submitted to the MLTC plan's manager in BMLTC and to the DOH MLTC email account.

According to the new transition guidance, DOH will be issuing additional guidance and requesting plan attestations regarding the other performance standards enacted in the budget legislation in the coming weeks.

Contact: Karen Lipson, klipson@leadingageny.org