4403f.(11b.) VNS Health, a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from Senior Network Health, a Partial Capitation Plan

VNS Health, a Partial Capitation MLTC plan in New York State, acquired the Senior Network Health, Partial Capitation membership effective June 1, 2024, and agreed to offer 120 days continuity of care to Senior Network Health members.

There were 324 members that transferred from Senior Network Health to VNS. 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 324 Senior Network Health enrollees who transferred to VNS one year following expiration of the continuity of care period is presented below. Overall, members saw no change in their hours.

Service Authorization changes for Prime Enrollees who transferred to VNS
No Change 324
Adult Day Medical Model Upon Enrollment 7
Member Disenrolled 58
Long Term Care Placement 26
Professional Services Authorization at Enrollment 33
No LTSS on Enrollment 3
No Note / Comment 197
Grand Total 324

Additionally, from the sample of 324, 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 Senior Network Health 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.