DOH Details State Budget Implementation Plan, Other MLTC Updates

The state Department of Health (DOH) held its monthly Managed Care Policy and Planning meeting last week where DOH representatives provided an update of the 2020-2021 enacted state budget and its implications for Managed Long Term Care (MLTC) plans and other long term care providers.

DOH will be sending letters to plans next week which will provide guidance and new timeframes for the 2020 enrollment lock-in periods as well as the three-month nursing home benefit limit for long term nursing home stay patients. DOH also stated that Maximus has been selected as the new MLTC Independent Assessor. That process will go into effect on October 1, 2020 and plans will be utilizing Maximus’s assessments to develop the care planning for each new enrollee.

DOH also provided guidance on Medicaid coverage and managed care enrollment extensions during the COVID-19 emergency, information on COVID-19 testing, a review of cost reporting due dates, as well Medicaid guidance regarding telehealth coverage.

DOH then provided an update on its Coordination of Benefit Agreement (COBA) with Medicare which requires Medicaid Managed Care Plans (MMCPs) to enter into a COBA with Medicare and participate in an automated claims crossover process. MMCPs must coordinate with Medicare for the time period where an enrollee gains eligibility for Medicare until disenrollment.

Finally, DOH provided an update on the 12-monthly enrollment numbers for each of its MLTC products (Partial Capitation, PACE, MAP, MA and FIDA) plans.

Further details on each of these items can be reviewed in DOH’s slides at the links below.