Elevance Health’s Anthem Blue Cross and Blue Shield in New York is ending contracts with more than 200 social adult daycare facilities, according to a Nov. 5 Politico report.
Social adult daycares provide supervision, care and socialization for people who are chronically ill or disabled. An Elevance spokesperson told Becker’s that 120 social adult daycare providers are still part of Anthem BCBS’ network. The spokesperson said Elevance regularly assesses and adjusts provider networks “to ensure they meet our members’ needs while we manage healthcare resources responsibly.”
“Following guidance from New York state and the Centers for Medicare & Medicaid Services (CMS), we analyzed the state’s social adult daycare program and made changes to our network to better align with our members’ service, cultural and language needs while maintaining geographic access to care,” the spokesperson said in a statement.
The termination dates span Jan. 1 to May 1, the spokesperson confirmed.
Adult daycares have been a target of fraud, waste and abuse initiatives. A New York City-based social adult daycare program director recently pleaded guilty to defrauding Medicare and the state’s Medicaid program of roughly $127 million, the Justice Department said Nov. 10.
In New York, social adult daycares do not enroll as Medicaid providers. Instead, managed long-term care plans vet these providers. In October, Politico reported on CMS concerns regarding state oversight of these plans, particularly due to alleged fraud with adult daycare providers.
