DOH Nursing Home/Managed Care Task Force Meeting Recap

Deanna Stephenson

On Wednesday, June 7th NYSHFA and other stakeholders met with key managed care policy staff at DOH. Plan and administrative issues identified by NYSHFA and our providers were discussed at this meeting, including those noted below.  The Department's power point that led the discussion is attached.

  • Medicaid Pharmacy – Providers are to bill MLTC pharmacy to FFS. Straight Medicaid services are billed to MCO directly.
  • Single Rate Cell – DOH is expected to resume discussion with CMS regarding  a single rate cell over this summer. Target, if approved would be April 2018. NYSHFA has indicated their support and assistance with CMS if needed.
  • Network Adequacy – DOH is keenly aware of the concerns raised by providers that lost managed care contracts. Details in attached  power point was last updated in April 2017.
  • Plan Rosters – Enrollment information now goes to the plan from local DSS or HRA to be updated on the plan rosters. Issue is that some plans share information with the nursing facility and some do not, leading to invalid and incomplete information for the facility. This is an issue that has been identified and working with DOH to find a resolve.
  • Medicaid Recertification Letters – Letters are being sent to the plan bypassing the provider. This is an issue that has been identified and NYSHFA is working with DOH to find a resolve.


NYSHFA /NYSCAL CONTACT:

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