Department Shares Further Guidance on Disenrollments
In a Dear Health Plan Administrator Letter dated April 26th, the Department of Health (DOH) provides an update on resuming involuntary disenrollment for enrollees who are not in receipt of community-based long-term services and supports (CBLTSS) in the previous calendar month. DOH will begin resuming this additional disenrollment process effective for disenrollment dates of July 1, 2022 and monthly thereafter. Managed Long Term Care (MLTC) plans are required to begin submitting disenrollments May 11th through June 9, 2022 and thereafter based on a distributed 2022 MLTC Plan Processing Schedule for Involuntary Disenrollments (revised April 6, 2022) available here for the additional Disenrollment Reason. The letter also includes member outreach requirements, as well as specific instructions for MLTC plans to submit the request to involuntarily disenroll the member including the required supporting No CBLTSS documentation to Maximus.
DOH reminds plans that the date of disenrollment depends on the date that the disenrollment request is received and accepted per the 2022 MLTC Plan Processing Schedule for Involuntary Disenrollments. Individuals will be notified of their disenrollment by NY Medicaid Choice. Fair Hearing rights apply, and the disenrollment notice has contact information if the individual disagrees with the disenrollment.
Individuals who are disenrolled from their MLTC plan will continue to receive their Medicaid coverage through another managed care plan or the Medicaid fee-for-service program. Prior to the effective date of disenrollment, plans must make all necessary referrals to another plan or local department of social services (LDSS) for all covered and non-covered services.
Plans must make arrangements to transfer the Plan of Care (POC) to the receiving plan or LDSS. If the member is auto-assigned to a Partially Capitated MLTC (MLTCP) plan, the receiving plan should continue the current POC until a new Community Health Assessment is completed and the POC is updated, which should be completed as soon as feasible, but no later than the next scheduled reassessment date.
More involuntary disenrollment resumption information is available here under Coverage and Billing Guidance subsection Other Guidance.
DOH and Maximus will co-host an instructional webinar on Fri., May 20, 2022 from 9:30 to 11 a.m. to review the processes for involuntary disenrollment. MLTC plans are encouraged to invite staff who process enrollment, disenrollment, and transfer requests, as well as case managers, to this webinar. Registration is required and available here.
LeadingAge NY Contact: Darius Kirstein, email@example.com, 518-867-8841