DOH Stakeholder Meeting – Limit the Nursing Home Benefit in Partially Capitated MLTC Plans

Deanna Stephenson

Yesterday DOH met with provider trade associations, health plans and long term care advocates to continue discussion on the budget item that is now part of the 2018-19 New York State enacted budget, which limits the nursing home benefit in partially capitated MLTC Plans. Below are updates from the discussion:

  • DOH is still working through a few items with CMS, therefore auto enrollments WILL continue to occur for newly identified Dual Eligibles moving to MLTC for long term care until further notice. NYSHFA is awaiting additional information from DOH.
  • DOH is formulating an evolving Frequently Asked Questions (FAQ’s) document with continued input from providers, plans and advocates.
  • CMS approval is still pending on the larger scale disenrollment of enrollees no longer in MLTC (approximately 22,000) back to Fee for Service. This action is being planned for July. DOH will continue to give updates.

One piece that is worth noting is the definition of when the 3 month clock will start once the enrollee exhausts their primary and third party insurance. The 3 month clock for those enrollees will start the 1st of the following month.

Deanna Stephenson
Director, Managed Programs
518-462-4800, ext. 16