MLTC Transition to FFS

Stephen Hanse and Carl Pucci in Finance & Reimbursement

DOH held a conference call earlier today to announce the implementation of the MLTC-FFS three-month benefit limitation, which is now scheduled to take place effective 8/1/20. Attached is the sample “Notice of Long-Term Care Medicaid Plan Disenrollment” which will be sent to SNF residents. DOH has contacted the MLTC plans with a listing of residents whose “chronic care budget is complete” with the goal of processing that batch of residents by the 8/1/20 disenrollment date. The disenrollment notice additionally provides the ability for residents and/or their families to assess their possible return to the community. If so notified, DOH would remove those residents from the initial disenrollment batch.

A DAL is expected to be issued either later today or tomorrow which will provide administrators a template to provide data on potential residents who may qualify for a return to the community. Responses to DOH will be due by next Tuesday, June 16, 2020.

DOH is not yet proceeding with having the MLTC plans initiate disenrollments, as additional guidance will be forthcoming. NYSHFA reminded DOH of the importance of messaging the timing of the NAMI collections to the MLTC plans with respect to the 8/1/20 disenrollment date. 


Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11

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