DOH Preparing for Next Batch Disenrollment Process of MLTC-Enrolled Nursing Home Residents
The Department of Health (DOH) is working on the next round of batch disenrollments of long-stay nursing home residents from Partially Capitated Managed Long Term Care (MLTCP) plans. The disenrollments will take effect June 1, 2024. Unless the individual is identified as working toward a return to the community or requests a fair hearing, residents meeting the criteria below will be transferred to Medicaid fee-for-service (FFS) effective June 1st:
- Resident is enrolled in a MLTCP plan;
- Resident’s status is identified as a long-term nursing home stay (LTNHS) (i.e., Local Department of Social Services (LDSS)-3559 or equivalent has been provided to the resident and submitted to LDSS); and
- Resident has been in a LTNHS for more than three months (LTNHS 3+).
A Dear Administrator Letter (DAL) dated March 22nd that describes the process is available here. To ensure that members who may be in the process of transitioning to the community are not disenrolled from their MLTCP plan, the Department is requesting that nursing homes use a template that was circulated with the notice to provide a list of their nursing home residents who have been designated LTNHS and who have an active discharge plan to transition to the community no later than Fri., April 5th. Instructions for using the secure transfer functionality of the Health Commerce System (HCS) to upload the file are available here.
Homes that do not have any members who fit the above criteria of an active discharge plan are asked to notify the Department by sending an email to DOH.sm.MLTCNH@health.ny.gov indicating that they have performed the review and do not have any residents who meet the criteria.
Please keep in mind that the change in the long-term nursing home care benefit has no impact on rehabilitative, short-term, or temporary nursing home residents and does not impact residents who may be Program of All-Inclusive Care for the Elderly (PACE) participants, Medicaid Advantage Plus (MAP) members, or mainstream Medicaid managed care enrollees.
DOH is fielding questions at MLTCNH@health.ny.gov.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841