4403f. (11b.) VNS Health, a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from Elderwood Health Plan, a Partial Capitation Plan
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VNS Health, a Partial Capitation MLTC plan in New York State, acquired the Elderwood Health Plan, Partial Capitation membership effective May 1, 2024, and agreed to offer 120 days continuity of care to Elderwood members.
Of the 1,134 members that transferred from Elderwood to VNS, a random sample of 1,000 members were selected. 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 1,000 randomly selected Elderwood enrollees who transferred to VNS one year following expiration of the continuity of care period is presented below. Overall, members saw no changes in their hours.
| Service Authorization changes for Elderwood Enrollees who transferred to VNS | |
|---|---|
| No Change | 1,000 |
| Mutual Case | 3 |
| Adult Day Health Care | 1 |
| Disenrolled | 171 |
| Enrolled with no LTSS | 10 |
| Long Term Care Placement | 16 |
| No Note / Comment | 799 |
| Grand Total | 1,000 |
Additionally, from the sample of 1,000, 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 Elderwood prior to the transition, Plan of Care from VNS 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.
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