Update on 3-Month Transition to FFS

Deanna Stephenson and Carl J. Pucci in Managed Care

DOH continues to work on the State’s transition from MLTC to FFS for long stay nursing home residents. The following is a brief status update on the State’s efforts:

  • Medicare Maximization - DOH is seeking to maximize the resident’s Medicare insurance and not counting the Medicare Co-insurance days before the 3-month clock starts.
  • Defining the 3-Month Clock – DOH is continuing to have internal discussions to define the 3-month starting date, the implementation process, and initiation of notifications to residents, providers and plans.
  • CMS Approval – Further discussions with CMS will occur once the implementation process is put in place to limit the benefit to 3 months. CMS will have to approve the amendment to the 1115 Waiver.

To date, processes with MLTC’s, providers and plans are status quo. NYSHFA / NYSCAL continues to have discussions with DOH toward a process for Limiting the Benefit and will give updates when available.

NYSHFA/NYSCAL CONTACTS: 

Deanna Stephenson
Director, Managed Programs
518-462-4800 x16

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36