RiverSpring at Home, a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from Montefiore HMO , LLC., A Partial Capitation Plan

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RiverSpring at Home (RiverSpring), a Partial Capitation MLTC plan in New York State, acquired the Montefiore HMO, LLC, Partial Capitation membership effective January 1, 2024, and agreed to offer 120 days continuity of care to Montefiore members.

There were 1,116 members that transferred from Montefiore to RiverSpring. 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 from Riverspring.

Service Authorization changes for Montefiore Enrollees who transferred to RiverSpring
No Change	1037
Hours remained Same	1037
Increase	68
Hours Increased after Transition	45
Member in SNF/Rehab/Hospital	5
Member is No Longer Enrolled	18
Decrease	11
Member Requested Decrease	10
Member is No Longer Enrolled	1
Grand Total	1116

The summary of the status of service authorizations for the 1,116 Montefiore enrollees who transferred to RiverSpring one year following expiration of the continuity of care period is presented above. Overall, members averaged an increase of 0.6 hours. Members who had a change in their plan of care, on average, saw an increase of 9 hours.

Additionally, from the sample of 1,116, 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 Montefiore prior to the transition, Plan of Care from RiverSpring 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, RiverSpring 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.