4403f.(11b.) VillageCareMAX, a Partial Capitation Plan, Post Acquisition Reporting of Member Service Authorizations from ArchCare Community Life., A Partial Capitation Plan

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VillageCareMAX, a Partial Capitation MLTC plan in New York State, acquired the ArchCare Community Life, Partial Capitation membership effective June 1, 2024, and agreed to offer 120 days continuity of care to Archcare members.

There were 4,242 members that transferred from ArchCare to VillageCareMAX. 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 4,242 ArchCare enrollees who transferred to VillageCareMAX following the expiration of the continuity of care period is presented below. Overall, members averaged an increase of 0.05 hours. Members who had a change in their plan of care, on average, saw an increase of 1.3 hours.

Service Authorization changes for ArchCare Enrollees who transferred to VillageCareMAX
No Change	4082
Hours remained the same	4082
Increase	145
Hours increased after transition	145
Decrease	15
Nursing Home Admission	2
Member requested reduction	13
Grand Total	4242

Additionally, from the sample of 4,242, 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 ArchCare prior to the transition, Plan of Care from VillageCareMAX 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.