Transitional Cases Service Plan Submission Tracking
November 2012 - April 2013
- STC#28: Transitional Cases Submission Summary Nov. ´12 - April ´13 (XLS, 53 KB)
Submission Tracking
| Plan Name | Initial Submission | Appeals and Fair Hearings |
|---|---|---|
| Aetna Better Health | Submitted (8 live-in/2 Split-shift/1 PC/CD) (11 Reductions/449 Total Transitions), included ALL transition cases |
Partial (0/0) |
| AgeWell New York | Submitted (0 Reductions/480 Total Transitions) |
Partial (0/0) |
| Amerigroup Corporation | 5/23 Submitted, Partial: (Live-in 2 Reductions/356 Total Transitions) MAP ( 0 reductions/0 total transitions) |
Partial (0/2) MAP (0/0) |
| Catholic Managed Long Term Care, Inc. d/b/a ArchCare Senior Life d/b/a ArchCare Community Life | Submitted Partial: (0 Reductions/374 Total Transitions), PACE (0/3) |
Partial (0/0) MAP (0/0) |
| CenterLight Healthcare | Partial: (8 PC.CD reductions/2097 Total Transitions) PACE: (1 PC.CD/64) |
Partial (0/0) MAP (0/0) |
| Centers Plan for Healthy Living | (0 Reductions/34 Total Tranistions) Submitted | Partial (0/0) |
| Elderplan, Inc. and HomeFirst, a product of Elderplan | (8 live-in/30 PC.CD ) (38 Reductions/ 1142 Total Transitions) MAP (3 PCCD Reductions/ Transitions 182) | Partial (0/0) MAP (0/0) |
| ElderServe Health, Inc. | (1 Live in/1 Split Shift Reductions/ 727 Total Transitions) Submitted | Partial (0/0) |
| EmblemHealth (HIP, GHI) | Partial (2PC.CD/ 341 Total Transitions) MAP (0 Reductions/ 8 Transitions) | Partial (0/0) MAP (0/0) |
| Fidelis Care | 6/12 resubmitted- Partial (4 SplitShift/ 1 Livein/ 2PCCD) (7 Reductions/4,285 Transitions) MAP (0/Reduction, 0/Transition) |
Partial (3/1) MAP (0/0) |
| GuildNet | Partial- (18 PC.CD , 1 Split Shift/ 19 Total Reductions/ 1535 Total Transitions) MAP (0/0) | Partial (0/0) Stated that clients requested reductions upon admission into plan |
| Healthfirst CompleteCare | Submitted (0 Reductions/ 565 Total Transitions) |
MAP (0/0) |
| HHH Choices Health Plan, LLC | (3 PC.CD Reductions/ 179 Total Transitions) Partial submitted, MAP (0/0) | Partial (1/1) MAP (0/0) |
| Independence Care System, Inc. | (LIVE IN-36 / Split Shift 19/ PC.CD 12) (67 reductions/ 1260 Total Transitions) Submitted |
Partial (38/2) |
| Metroplus MLTC | Submitted (0 Reductions/85 Total Transitions) |
Partial (0/0) |
| Senior Health Partners | Submitted (2 live-in/56 PC.CD) (58 Reductions/ 2278 Total Transitions) |
Partial (18/0) |
| Senior Whole Health | Submitted, Partial (0 Reductions/108 Total Transitions) MAP (0/0) |
Partial (0/0) MAP (0/0) |
| United Healthcare | Submitted, (0 Reductions/152 Total Transitions) |
Partial (0/0) |
| VillageCareMAX | Submitted (1 PC.CD Reduction/632 Total Transitions) | Partial (1/0) |
| VNS CHOICE | (1 Live In/ 1 split-shift/14 PC.CD) (16 Reductions/2,229 Total Transitions) Resubmitted correct 5/22 MAP (0/0) | Partial (0/0) MAP (0/0) |
| WellCare of New York | Partial submitted (5 Live-in/1 split-shift/7 PC.CD) (13 Reductions/411 Total Transitions) , MAP (0 Reductions/6 Total Transitions) |
Partial (0/0) MAP (0/0) |
| Totals: | |
|---|---|
| Reductions | 251 |
| Transitions | 19,800 |
| Appeals | 104 |
| Fair Hearings | 8 |
| Live ins | 64 |
| Splits | 29 |
| PC/CDs | 158 |
Submission Summary
| Plan Name | Live in | Split | PCCD | # of Reductions | # of Total Tranisitions | % of Reductions | # of Appeals | # of Fair Hearings |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health | 8 | 2 | 1 | 11 | 449 | 2.44% | 0 | 0 |
| AgeWell New York | 0 | 0 | 0 | 0 | 480 | 0% | 0 | 0 |
| Amerigroup Corporation (PARTIAL) |
2 | 0 | 0 | 2 | 356 | 0.56% | 0 | 2 |
| Amerigroup Corporation (MAP) | 0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| ArchCare Community Life (PARTIAL) |
0 | 0 | 0 | 0 | 374 | 0% | 0 | 0 |
| ArchCare Senior Life (PACE) |
0 | 0 | 0 | 0 | 3 | 0% | 0 | 0 |
| Centerlight Healthcare (PARTIAL) |
0 | 0 | 8 | 8 | 2097 | 0.38% | 0 | 0 |
| Centerlight Healthcare (PACE) |
0 | 0 | 1 | 1 | 64 | 1.56% | 0 | 0 |
| Centers Plan for Healthy Living |
0 | 0 | 0 | 0 | 34 | 0% | 0 | 0 |
| Homefirst (PARTIAL) | 8 | 0 | 30 | 38 | 1142 | 3.32% | 0 | 0 |
| Elderplan, Inc. (MAP) | 0 | 0 | 3 | 3 | 182 | 1.64% | 0 | 0 |
| Elderserve Health | 1 | 1 | 0 | 2 | 727 | 0.27% | 0 | 0 |
| EmblemHealth HIP (PARTIAL) |
0 | 0 | 2 | 2 | 341 | 0.58% | 0 | 0 |
| EmblemHealth HIP (MAP) |
0 | 0 | 0 | 0 | 8 | 0% | 0 | 0 |
| Fidelis Care (PARTIAL) | 1 | 4 | 2 | 7 | 4,285 | 0.16% | 3 | 1 |
| Fidelis Care (MAP) | 0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| GuildNet (PARTIAL) | 0 | 1 | 18 | 19 | 1,535 | 1.23% | 0 | 0 |
| GuildNet (MAP) | 0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| Healthfirst CompleteCare |
0 | 0 | 0 | 0 | 565 | 0% | 0 | 0 |
| HHH Choices Health Plan (PARTIAL) |
0 | 0 | 3 | 3 | 179 | 1.67% | 1 | 1 |
| HHH Choices Health Plan (MAP) | 0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| Indepence Care System | 29 | 6 | 9 | 44 | 1,260 | 3.49% | 38 | 2 |
| Metroplus MLTC | 0 | 0 | 0 | 0 | 85 | 0% | 0 | 0 |
| Senior Health Partners | 2 | 0 | 56 | 58 | 2,278 | 2.54% | 18 | 0 |
| Senior Whole Health (PARTIAL) |
0 | 0 | 0 | 0 | 108 | 0% | 0 | 0 |
| Senior Whole Health (MAP) |
0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| United Healthcare | 0 | 0 | 0 | 0 | 152 | 0% | 0 | 0 |
| VillageCareMAX | 0 | 0 | 1 | 1 | 632 | 0.15% | 1 | 0 |
| VNS CHOICE (PARTIAL) | 1 | 1 | 14 | 16 | 2,229 | 0.71% | 0 | 0 |
| VNS CHOICE (MAP) | 0 | 0 | 0 | 0 | 0 | 0% | 0 | 0 |
| WellCare of New York (PARTIAL) |
5 | 1 | 7 | 13 | 411 | 3.16% | 0 | 0 |
| WellCare of New York (MAP) |
0 | 0 | 0 | 0 | 6 | 0% | 0 | 0 |
| Totals: | 57 | 16 | 155 | 228 | 19,982 | 1.14% | 61 | 6 |
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