DOH Issues Direction Regarding MLTC Enrollees Needing Assisted Living Program Services

The Department of Health's (DOH) Bureau of Managed Long Term Care (MLTC), Division of Health Plan Contracting and Oversight, in the Office of Health Insurance Programs sent the below message to MLTC plans on Dec. 18, 2023:

Reminder: Assisted Living Programs (ALP)

Individuals admitted to ALPs are excluded from enrolling into Managed Long Term Care plans; unless in a specific CMS-approved PACE-demonstration ALP. If a MLTC Enrollee is disenrolling from the Contractor’s MLTCP to receive services through an ALP, the MLTC plan must pay the applicable Medicaid rate for the level of care for which the Enrollee is assessed, using the appropriate assessment tool, until the disenrollment from the MLTCP. The MLTC program does not have a retroactive disenrollment recovery reason for admission to an Assisted Living Program and therefore, the MLTC disenrollments must be processed prospectively from the date of notice.

Please contact mltcinfo@health.ny.gov with any questions.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828