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MLTC Lock-in Policy, Change in NH Benefit Await CMS Action

Although the Department of Health (DOH) anticipates that the Centers for Medicare and Medicaid Services (CMS) will approve its request to make changes to the Managed Long Term Care (MLTC) nursing home benefit, implementation dates remain uncertain. The provision would amend the State’s Medicaid Redesign Team (MRT) demonstration by limiting the nursing home benefit in MLTC to three months after a plan member is designated as a permanent resident of a nursing home. The resident would revert to fee-for-service Medicaid after a three-month period (as long as the individual was qualified for institutional Medicaid coverage).

In its letter to CMS, the State lists Nov. 1, 2018 as the date on which new permanent nursing home residents who are not enrolled in an MLTC plan and whose care is paid for by Medicaid would no longer be required to enroll in MLTC. Implementation on that date may be unlikely given that the comment period for the proposal has been extended through Nov. 23rd. The letter lists Jan. 1, 2019 as the effective date for the three-month enrollment limit for permanent residents who are enrolled in MLTC. That would mean that nursing home residents who are enrolled in an MLTC plan and who have been in a permanent placement status for three months or longer would start being disenrolled from plans and transferred to fee-for-service Medicaid. The State had originally envisioned this to occur over the course of a number of months beginning in July 2018.

Please note that this change will impact members of partially capitated MLTC plans only; permanent nursing home members enrolled in Fully Integrated Duals Advantage (FIDA) or Medicaid Advantage Plus (MAP) or participating in Programs of All-Inclusive Care for the Elderly (PACE) will not be affected.

The same letter includes a request for federal approval to implement an enrollment “lock-in” provision for members of partially capitated MLTC plans effective Dec. 1, 2018. That provision would limit the ability for members to transfer from one partially capitated plan to another for a 12-month time period. Transfers would not be limited during the first 90 days of enrollment and would also be allowed during the lock-in period for good cause.

The letter to CMS as well as the draft notices that would be used to notify plan members are available here.

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