Medicaid Managed Long Term Care Health Insurance Training

Medicaid Managed Long Term Care Health Insurance Training Center (HITC) New York State Public Health Insurance Programs 2017 6/16/2018

2017 2 Restriction/Exception Codes • For managed care enrollees, once budgeting and long term eligibility is approved, the LDSS will enter specific Restriction/Exception (R/E) codes into e. Med. NY to identify the type of long term placement. • For consumer with FFS coverage, N 7 is entered once the eligibility determination is complete, and any penalty period has elapsed to begin the outreach and enrollment process.

2017 3 Nursing Home Transition Rate Code Billing Matrix and R/E Codes Managed Care Program R/E Code Description MMC MLTC N 1 Regular SNF Rate – MC Enrollee X N 2 SNF AIDS – MC Enrollee X N 3 SNF Neuro-Behavioral – MC Enrollee X N 4 SNF Traumatic Brain Injury – MC Enrollee X N 5 SNF Ventilator Dependent – MC Enrollee X N 6 Any MLTC Enrollee N 7 NH Budgeting Approved – Awaiting MC Enrollment X X X

2017 4 Plan Selection and Enrollment: • Consumers residing in a nursing home who are newly determined eligible for long term placement have 60 days to select a plan for enrollment. • Consumer will select from plans contracting with the nursing home in which the individual resides. • New York Medicaid CHOICE ios available to assist consumer with education and plan selection (in enrollment broker counties only). • If a plan is not selected within 60 days, a consumer is auto -assigned into a plan that contracts with the nursing home.

2017 5 Net Available Monthly Income (NAMI) • Plans are responsible for NAMI collection and may delegate this to the NH. • Local districts are responsible for notifying the Plan, the consumer (and their representative if appropriate) via the notice process of the NAMI and any NAMI changes not appearing in the budget