- The information in this letter supersedes the information contained in the January 21, 2020 letter.
- The DOH is requesting nursing homes transmit a list of all residents designated as long-term nursing home stay (LTNHS), enrolled in MLTCP Plan, & have an active discharge plan to transition to community no later than June 16, 2020.
- Per 12/2019 amendment to NY MRT 1115 Demonstration Waiver, the NH MLTCP plan benefit is limited to 3 months of LTNH care for individuals designated long-term stay or permanently placed. The 3 months begins on the 1st day of the month following the month of the effective date of the LTNHS designation documented by the NH, in conjunction with authorization by the MLTCP plan, on the form or an approved local equivalent. Note that the change has no impact on rehabilitative, short terLDSS-3559, “Residential Health Care Facility Report of Medicaid Recipient Admission/Discharge/ Readmission/Change in Status,” m or temporary nursing home residents.
- As per DOH 1/21/20 letter, individuals designated LTNHS have been excluded from enrollment into an MLTCP plan. The change in the NH benefit does not apply to any other MLTC product including FIDA, FIDA-IDD, PACE, MAP or Mainstream. New admissions and changes in status after the receipt of this letter, NH will be required to provide a copy of the LDSS-3559 to the resident, and any other individual representing the patient and the resident’s local department of social services (LDSS).
- Members enrolled in MLTCP & designated as LTNHS for more than 3 months & determined by DSS financially eligible for NH Medicaid will be disenrolled from MLTCP on 8/1/20 & converted to FFS.
- Members will receive a notice at least 10 days prior to disenrollment.
- Member can request an assessment to see if their needs can be met safely in the community. If requested before their disenrollment date they will not be disenrolled from their MLTCP until notified by the plan of the plan’s decision.
- Any excess income monthly is to be paid directly to the nursing home.
- An active discharge plan means a plan that is being currently implemented. Meaning the resident’s care plan has current goals to make specific arrangements for discharge and/or staff are taking active steps to accomplish discharge. An active discharge plan includes situations where: resident is currently being assessed for transition by the Local Contact Agency; or resident has a Transition Plan in place, with all elements incorporated into Discharge Plan; or resident has an expected discharge date of three (3) months or less, a discharge plan in place and discharge plan can’t be improved upon with a referral to the Local Contact Agency. In New York, the Local Contact Agency is Money Follows the Person/Open Doors and they can be reached at 844-545-7108.
- Nursing homes are reminded of the obligation to ensure that all residents who express a desire to return to the community are provided the opportunity and assistance to allow the resident to live in the most integrated and least restrictive setting possible. For additional information see Dear Administrator Letter 16:10, dated February 16, 2017, Dear Administrator Letter 18-05, dated September 4, 2018 and Dear Administrator Letter 19-16, dated October 11, 2019. Open Doors can also be reached at 844-545-7108. If you are able to safely leave the nursing home and return to the community within six months of Plan Disenrollment Effective Date you will be presumed eligible for enrollment into an MLTC Medicaid Plan. To re-enroll in an MLTC Medicaid Plan, contact New York Medicaid Choice.