Requires Medicaid fee-for-service coverage of managed long term services and supports when beneficiary is pending enrollment in managed care organization.
The implementation of SB 413 will enhance the financial security of Medicaid beneficiaries, particularly those in assisted living settings, by preventing delays in coverage that can hinder access to essential services. This provision addresses a critical concern that arises during the enrollment process, where beneficiaries often experience difficulties in reimbursement for necessary services as MCO enrollment can extend up to 60 days. By formalizing the requirement for FFS coverage, the bill codifies existing practices and provides a legislative framework to ensure ongoing support for these vulnerable populations.
Senate Bill 413 seeks to ensure that Medicaid recipients who are waiting to enroll in a managed care organization (MCO) do not experience gaps in service coverage for long-term services and supports. Specifically, the bill mandates that the Division of Medical Assistance and Health Services (DMAHS) provide fee-for-service (FFS) coverage for eligible services from assisted living residences, comprehensive personal care homes, and other such facilities once an individual has been determined clinically and financially eligible for the Medicaid Managed Long Term Services and Supports program but is still awaiting their MCO enrollment. The coverage is required to begin the moment eligibility is confirmed and continues until MCO enrollment is effective.
While the bill is positioned to streamline Medicaid service provision, discussions surrounding the legislation may center on the operational readiness of the DMAHS to implement the required changes and whether the necessary state plan amendments or waivers can be efficiently secured to avail federal financial participation under the Medicaid program. Concerns could also arise regarding the sustainability of this funding model, the administrative burden on healthcare providers, and how well the transitions between FFS and MCO will be managed for beneficiaries.