Skilled nursing: utilization management and Medicaid permanent placement update
Utilization management after 90 days
Please note that eviCore only manages members in Skilled Nursing, Inpatient Rehab, and Long-Term Acute Care facilities for 90 days. Thereafter, you will need to contact EmblemHealth at 888-447-2884 to address ongoing inpatient days.
Permanent placement process for Medicaid members
If a Medicaid member needs long-term residential care, the facility must request increased coverage from the Local Department of Social Services (LDSS) via submission of the LDSS-3559 (DOH-5182) form (or equivalent) within 48 hours of a change in a member’s status. The facility must also submit to the LDSS a completed Notice of Permanent Placement Medicaid Managed Care (MAP form) within 60 days of the change in status. The facility must also notify EmblemHealth of the change in status. If requested, the facility must submit a copy of the MAP form to EmblemHealth for approval prior to the facility’s submission of the MAP form to the LDSS. Payment for residential care is contingent on the LDSS’ official designation of the member as a “Permanent Placement