Harmony Healthcare Blog

New York State Transitions to Medicaid Managed Care Plan March 1st

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Mar 04, 2014

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Edited by Kris Mastrangelo

Effective March 1, 2014, all eligible beneficiaries over the age of 21 in New York City, Nassau, Suffolk and Westchester counties, in need of long term placement in a nursing facility, will be required to join a Medicaid Managed Care Plan (MMCP) or a Managed Long Term Care Plan (MLTCP).  The rest of New York State is scheduled to begin transitioning this coming September for both dual and non-dual eligible populations and all upstate counties will be phased in by December 2014.

Those beneficiaries currently receiving long term care in a nursing home will not be required to enroll in a managed care organization (MCO) at this time, however, voluntary enrollment will be allowed six months after the implementation of the initial transition.  Per the New York State transition document, the ultimate goal is to foster a care delivery model that promotes transitional planning across the health care delivery system with the focus on providing services in the community whenever possible.

New York State has provided a basic outline of the procedures for currently enrolled MCO beneficiaries and those dually eligible individuals not currently enrolled.  Historically, when a beneficiary was admitted from a hospital or from home, and they completed a rehabilitation stay, the physician and IDT would make the initial determination as to whether or not the resident required long term care. Now, since these changes have gone into effect, the actual recommendation for long term placement must be made by the MCO in collaboration with the IDT.

The regulation states that the MCO, with input from the SNF, physician and beneficiary/designee, will review all pertinent documentation and consider the most appropriate level of care, equipment and supplies that will be required.

New York State has also outlined basic requirements including continuing with the current assessment processes including PRI, PASSR and MDS assessments as well as comprehensive assessments or updated assessments per the UAS-NY (Unified Assessment System for New York).  Details on the transition program including the process of determining eligibility requirements, network vs. out of network provisions and bed hold impacts are available at:

https://www.leadingageny.org/topics/medicaid-redesign/

We encourage all facilities to:

  • Meticulously review each negotiated agreement made with MCOs
  • Understand the specific requirements of each individual contract and key MCO personnel
  • Disseminate the information with all appropriate personnel

In conjunction, Harmony (HHI) urges facilities to review their current admission, transition and discharge processes to ensure early identification of those individuals that will be impacted by the forthcoming changes.  Harmony (HHI) is available to assist facilities in reviewing and revising current processes.

Have questions? Feel free to leave them in the comments section below.

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Tags: Medicaid, Medicaid Reimbursement, Managed Care

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