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Timely updates as PHE ends

On January 30, 2023, the White House announced that the COVID-19 Public Health Emergency (PHE) will end on May 11, 2023. With the end of the PHE, some of the ways we have been able to work together and communicate will change. Effective May 11, 2023, with the end of the PHE, the following flexibilities have ended.

Face-to-Face Flexibility Ends

In-person Face-to-Face flexibilities have ended unless specifically requested by the member or representative. Telehealth (virtual) services can only be provided if Members or their representatives affirmatively request remote contacts over in-person and an addendum is made to the life plan reflecting this choice. Telehealth support must be face-to-face (i.e., the Care Manager can see the Member or Member representative and that person can see the Care Manager), meet the Member’s needs, and are effective. If engaging remotely becomes ineffective, unsafe, or does not meet the Member’s needs, it must be discontinued. At a minimum, Care Managers must meet in person with Members at least twice annually, although there could be more required in-person visits based on service type. Annual Life Plan meetings must be conducted in person. Members may opt out of virtual meetings at any time.

To protect members’ privacy, ACA/NY and LIFEPlan CCO will only conduct telehealth meetings utilizing the Teams platform. Meeting apps such as Facetime, WhatsApp, Google Meet, or others will no longer be approved for meetings for any reason with Care Managers.

Tiers 1-3

A minimum of quarterly Face-to-Face (FTF) contact (January-March, April-June, July-September, and October-December) is required. If the person requests remote FTF contacts, and it is deemed appropriate, there is a minimum requirement of two in-person contacts annually.

  • The annual Life Plan meeting must occur in person.
  • The other in-person contact can occur at the semi-annual Life Plan review meeting OR a meeting for another purpose.
  • A minimum of at least one (1) in-person contact per six (6) month period is required.
  • All other required FTF contacts could occur through Remote contact based on the Member’s request.

Tier 4 Non-Willowbrook Class Member

  • If the person requests remote FTF contacts, and it is deemed appropriate, there is a minimum requirement of at least one (1) in-person contact per quarter during the calendar year.
  • The annual Life Plan meeting must occur in person.
  • The other in-person contacts can occur at the semi-annual Life Plan review or for other purposes.

Tier 4 Willowbrook Class Members

  • Monthly in-person contact is required. There are no telehealth flexibilities for Willowbrook Class Members. All visits must occur in person.
  • At least one Care Manager Observation Report (CMOR) report must be completed between May 11, 2023, and November 11, 2023, for all Willowbrook Class Members.

The Life Plan annual meetings, as mentioned above, must be held in person. The annual Life Plan date can no longer be extended. It must be completed by the end of the month in which the previous annual review was completed.

LCED

Level of Care Eligibility Determination (LCED) Annual Redetermination extension has ended. ACA/NY and LIFEPlan CCO continued the LCED redetermination policy, with extensions, during the PHE.

  • In March 2023, ACA/NY’s and LIFEPlan CCO’s Care Management teams redetermined every Member’s LCED.
  • ACA/NY and LIFEPlan CCO have an 11-month redetermination policy for LCEDs, and they will next be redetermined in February 2024.
  • Annual Redeterminations are uploaded to CHOICES under “Supporting Documents.”
  • LCEDs will be distributed with the annual Life Plan.

Life Plan Approvals

After May 11, 2023, Care Managers can no longer obtain verbal or email approval of the Life Plan.

Medicaid Recertification Easements Ending

Under the Consolidated Appropriations Act of 2023, the continuation of Medicaid easements is no longer tied to the Public Health Emergency (PHE). As of April 1, 2023, the easements will begin to be lifted.

Renewals started in March 2023 in New York City and April 2023 in the rest of the state. All 7+ million Medicaid recipients will receive renewals over a 12-month period. Effective July 1, 2023, all new Medicaid applications will be processed without easements and will require full documentation on new applicants.​

Medicaid-only cases with authorization ending June 30, 2023, or later must submit their renewals on time with the required documentation. Otherwise, Medicaid can be discontinued. Medicaid-only cases with authorizations ending May 30, 2023, or earlier should still be extended automatically, even if the renewal is not returned.

The first discontinuance of Medicaid for those determined to be no longer eligible based on their renewal or who do not respond to the renewal start in July 2023.

Those whose spend-down increases from the old amount will receive notice of the increase starting effective July 1, 2023. Because of the 2023 increases in income limits, few people should see an increase in their spend-down.

Please note: Updated addresses must be on file with the Medicaid office.