4403f. (11b.) Elderplan, a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from EverCare Choice, a Partial Capitation Plan

Elderplan, a Partial Capitation MLTC plan in New York State, acquired the EverCare Choice, Partial Capitation membership effective May 1, 2024, and agreed to offer 120 days continuity of care to Archcare members.

There were 679 members that transferred from EverCare to Elderplan. A listing of the personal care hours each member was receiving prior to transition, as well as after the transition upon reassessment, along with the changes in personal care hours, if any, was requested. Additionally, for any instance of a decrease in hours an explanation for the decrease with supporting documentation was requested.

The summary of the status of service authorizations for the 679 EverCare enrollees who transferred to Elderplan one year following expiration of the continuity of care period is presented below. Overall, members saw an increase of 2.66 hours. For members who had their hours changed, they saw an increase of 11.7 hours.

Service Authorization changes for EverCare Enrollees who transferred to Elderplan
No Change 377
Hours remained the same 373
Member Permanently Place 4
Increase 103
Hours increased after transition 103
Disenrolled 188
Decrease 7
Plan Initiated Reduction 1
Member Initiated Reduction 6
Change in Plan of Care 4
Member Permanently Placed 4
Grand Total 679

Additionally, from the sample of 679, 50 members were selected for a case review. The case review was performed to validate the accuracy of the information provided by the Plan on Service Authorization changes. The information and/or data received consisted of a Plan of Care from EverCare prior to the transition, Plan of Care from Elderplan after reassessment, Care Management notes, and any service request determination or plan action notices sent for the time frame specified. Additionally, after the initial request, the Plan was asked to submit supplementary information for specific enrollees to further clarify potential issues. Upon review of the supplementary information, the accuracy of the submitted data was able to be verified.