Court Blocks Medicare Advantage Switch The Retired Public Employees Association (RPEA),…
RPEA has been informed that our challenge to the New York State Health Insurance Program (NYSHIP) regulation regarding access to Skilled Nursing Facility (SNF) services is now being reviewed by the Department of Financial Services. RPEA is challenging the lower level of access to SNF services when Medicare coverage is primary.
We had initially raised the issue with the Council on Employee Health Insurance which is responsible for overseeing NYSHIP. The Council responded that the Empire Plan is compliant with all state and federal requirements, without providing any specific proof. Hence, our appeal to the Department of Financial Services for a determination if that statement is, in fact, accurate.
RPEA claims that the current practice regarding referral to a SNF is discriminatory, based solely on age. Medicare primary patients can only be referred to a SNF after spending three days in the hospital. No such requirement exists for lower age NYSHIP enrollees, who have yet to become Medicare eligible.
We pay the same premium as active enrollees, and presumably have access to the same level of service. This is certainly not true regarding access to a SNF.
We will keep you posted, as the Department of Financial Services considers our appeal. This is yet one more example of RPEA protecting the benefits of retirees. RPEA is the only organization which has this as its SOLE purpose.