MLTC Transition to FFS – Update

Carl J. Pucci in Finance & Reimbursement

In advance of the upcoming MLTC transition to FFS, on schedule for 8/1/20 (see NYSHFA MM) DOH has issued the following update related to the plans:

The NH resident report for July 2020 that we provided to plans did not include the NYC members to be disenrolled (as described below) on August 1, 2020.  We have provided to the plans a supplemental file which will include those members and have sent them the following note.

Dear Health Plan Administrators: 

The process for disenrolling Managed Long Term Care Partial Capitation Plan (MLTCP), members effective August 1, 2020, who were designated as long term nursing home stay (LTNHS), and had been in a LTNHS for more than three months (LTNHS 3+) and had been determined by the local social services district to be financially eligible for nursing home Medicaid coverage (the “Batch” Nursing Home benefit limit disenrollment) has been implemented.

We are writing to let you know that the nursing home resident report you received for July 2020 does not include New York City members that will be disenrolled as described above.  To provide you this information, we will provide to you a supplemental file which contains a list of all New York City members enrolled in your Plan due for disenrollment effective August 1, 2020, including their respective NAMI amounts, and their nursing home provider identification.

The supplemental file will be sent to the designated compliance contacts for the New York City Partial Capitation plans via the Health Commerce System on Tuesday, July 21, 2020.

To facilitate the change from capitation to fee for service for the downstate population, the N6 code attached to these members was closed on June 24, 2020.  This was done to allow the placement of the principal provider code effective August 1, 2020 on each member’s file. The elimination of the N6 code does not eliminate the requirement that the Plan pay all incurred covered services, including nursing home payments to the nursing home through July 31, 2020.

If you have any questions, please contact: 

MLTC Plans: 

Division of Long-Term Care
Office of Health Insurance Programs
NYS Department of Health 


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