I want to let you know that we are so proud of our New York skilled nursing facilities! Amazing what you guys pulled off!
If everybody is not familiar, in New York there’s a safety rule – “If you see something say something” – and that’s exactly what New Yorkers did in skilled nursing facilities.
They said that it doesn’t make sense for MLTC’s to be required to cover long-term patients in a skilled nursing facility, so they pushed back. The skilled nursing facilities pushed back, the associations in New York pushed back, and they got what they wanted.
As of February 1st, there is no longer going to be a requirement for MLTC’s to cover a patient that is long-term in a skilled nursing facility in New York.
How is that going to affect you? In three ways.
Before I get to that, I want to give a quick thank you to Jacob Friedman for giving me this information so clearly and understanding how it affects every facility in New York.
So the 3 scenarios are if somebody is already in a skilled nursing facility for 90 days, that is enough determination that they’re going to be long term, and therefore as of February 1 they will move to Medicaid fee-for-service.
So, if you’re familiar with epaces, that means they’ll be moving from an N to an NH on New York Medicaid.
If somebody is in a skilled nursing facility under a MLTC, but have not been there yet for 90 days, they will remain under the MLTC for the 90 day period and then move over to Medicaid fee-for-service at that point.
The last category is someone who is applying for long-term Medicaid. Once they’re determined to be eligible for Medicaid and determined that they are long-term, will move directly onto Medicaid fee-for-service not even getting enrolled in a MLTC at all.
So this is a major change for New York and it’s really exciting!
And for my Illinois friends, yes, you guys pulled off months ago that the managed Medicaid do not require the authorizations, but you’re still working with the managed Medicaid.
It’s exciting to see in New York that the managed Medicaid for long-term skilled nursing facility is completely going away!
So, if I gave an example, I would say that New York is kinda like quitting smoking cold turkey while Illinois is still vaping. You guys are still kind of hooked but hopefully you’ll get there and hopefully all states will get there soon. And as the industry shifts of course everyone is shifting along with that.
If anybody has any questions for New York facilities about how this is going affect your facility and how this is going to affect your case management, your staff, and your contracting, feel free to reach out to me.
I’d be happy to answer your questions and help out.
Have a great day!
Contracting • Case Management • CHOW’s