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State Preparing for MLTC Nursing Home Benefit Change

Members should have received a Dear Administrator Letter (DAL) from the Department of Health (DOH) on Jan. 21st discussing the State’s timeline for shifting back to fee-for-service (FFS) those individuals who have been in a long-term nursing home stay for longer than three months and who are enrolled in a partially capitated Managed Long Term Care (MLTC) plan. The change is scheduled to take effect on March 1, 2020 for all areas outside of New York City (NYC) and on April 1, 2020 in NYC. The DAL is available here, and links to the accompanying consumer notice letters being used are accessible here: a) letter from DOH that all MLTC members will receive; b) letter from Medicaid Choice that nursing home residents will receive.

DOH requests that homes provide a list to the Department by Jan. 28th of residents who are in a long stay but who have an active discharge plan to return to the community. This will help ensure that these individuals are not disenrolled. The DAL provides the criteria for what constitutes an “active discharge plan.” The Department requests that homes submit a list of such residents with their name, Client Identification Number (CIN), the date on which they were determined to be a long-stay resident, and the MLTC plan in which they are enrolled. The submission should also include your facility name and contact information for the individual submitting the list. Please be sure to transmit the list through the Health Commerce System (HCS) Secure Transfer to MLTCNH@health.ny.gov.

To access Secure Transfer, log on to the HCS and select “My Content,” “All Applications,” “S,” and “Secure File Transfer 2.0.” Click on “Launch the Secure File Transfer 2.0” under Package Actions, then click “Send Package.” Please address the file to MLTCNH@health.ny.gov.

DOH has requested that all homes respond, including those with no residents in active discharge status. If your facility has no such residents, please indicate so, and include your facility name and opcert. Alternatively, you can email "none" to LeadingAge NY, and we will pass that information along to DOH (please do not send us any resident-identifying information).

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