DOH Briefs MLTC Plans, Association on Latest Enrollment Numbers and Policy Updates 

Situation Report | March 15, 2021

The state Department of Health (DOH) presented the latest enrollment numbers at its monthly Managed Care Policy and Planning meeting (see here). It also provided a reminder about reporting due dates, an update on the nursing home disenrollment process, and discussion on the Independent Assessor program, which is the subject of a separate article in this week’s Situation Report.

Report Due Dates

  • The Medicaid Medical Loss Ratio (MLR) Report for State Fiscal Year (SFY) 2019-20 is due March 26, 2021.
  • The following items are due April 1, 2021: Calendar Year 2020 Medicaid Managed Operating Reports (MMCORs) for all Medicaid Managed Care Plans, including MLTCs and PACE plans; Audited Financial Statement; and the 2020 Reconciliation Worksheet.
  • March 31, 2021 Escrow Bank Account Statements are due April 30, 2021.

Nursing Home Benefit Limitation

State officials said they have successfully initiated and completed the “batch process” disenrollment for long term nursing home stays. These individuals have been converted to Medicaid fee-for-service (FFS) for ongoing coverage of their long term nursing home care effective April 1, 2021.

Members who were not disenrolled through the “batch process” either did not meet the criteria listed below or were not able to be converted to Medicaid FFS billing for ongoing coverage of their long term nursing home care. The “batch process” included members who met the following criteria:

  • Member is designated as long term nursing home stay (LTNHS).
  • Member has been in a LTNHS for more than three months.
  • Member has been determined by the local department of social services (LDSS) to be financially eligible for nursing home Medicaid coverage.