News & Insights

News & Insights

Kathleen Carver Cheney presented a seminar for the Greater New York Health Care Facilities Association on the topic “Managed Care Expands to Nursing Homes: Are You Ready?”

Kathleen Carver Cheney presented a seminar for the Greater New York Health Care Facilities Association on the topic “Managed Care Expands to Nursing Homes:  Are You Ready?”  As of March 1, 2014 (or later if the effective date is extended by DOH) all new Medicaid-eligible nursing home admissions in downstate counties will be required to enroll in a managed care plan.  Existing downstate residents are not required to enroll in plans, but may voluntarily enroll 6 months later, which is also the point at which new admissions in upstate counties will start mandatory enrollment.  Voluntary enrollment of existing upstate residents will begin 6 months later.

 

Although nursing homes are currently experiencing difficulty getting contracts with plans, DOH is working with associations on both sides to facilitate the contracting process.  DOH formally requires plans to contract with 8 nursing homes in most downstate counties (and only 5 in New York and Richmond Counties), but the long term goal is that plans will contract with most if not all nursing homes in order to accommodate resident and family choice.  Nursing homes and plans will be incentivized to provide high quality efficient care and to return residents to the community whenever possible.

 

The rollout of mandatory managed care for nursing home residents is part of the larger Medicaid redesign program which seeks to avoid unnecessary hospitalizations, emergency room visits and nursing home admissions.