DOH Issues New MLTC Policy Regarding Social Day Program Transportation
(July 16, 2024) On July 1st, the Department of Health (DOH) Office of Health Insurance Programs (OHIP) issued Managed Long Term Care (MLTC) Policy 24.01, which will require social adult day care (SADC) programs to arrange or provide transportation to and from program through their own contracts with transportation vendors. Programs will receive payment from MLTCs or Medicaid Advantage Plus (MAP) plans to pass on to their contracted vendors. The policy goes into effect Jan. 1, 2025.
On March 1, 2024, the State carved out the MLTC transportation benefit with the intention of having all non-emergency transportation provided fee-for-service to MLTC beneficiaries through Medical Answering Service (MAS), NY's statewide transportation broker. Knowing that many SADC programs had their own fleets or were arranging their own transportation, they allowed, and continue to allow, a hybrid model so that programs can continue to carry out transportation as provided, with the MLTC-managed transportation moving to MAS.
The Department stated that this hybrid option was a temporary plan until it could inventory the transportation methods of SADC programs. With the inventory now complete and revealing that most programs provide or arrange their own transportation with reimbursement from plans, this will be the policy effective Jan. 1, 2025.
This policy does not apply to Programs of All-Inclusive Care for the Elderly (PACE programs) or to the SADC service providers that only contract with PACE programs.
According to the policy, effective Jan. 1, 2025, SADC transportation will remain a covered benefit under MLTC plans, and SADCs will no longer have the option of their transportation being carved out to FFS. All SADCs will be responsible for managing their own transportation. SADC programs can opt to use their own vehicles or contract directly with transportation vendors to secure transportation of SADC members to SADC programs. The Department is providing this policy in advance of the implementation date to allow MLTC plans time to educate and assist their SADCs with implementing these changes and initiating new contracts with vendors.
Before Jan. 1, 2025, SADCs must transition any members whose trips to and from the SADC are arranged through their contracted MLTC, MAP plan, or through MAS to having their trips arranged and paid for by the SADC they are attending.
SADCs that do not currently provide transportation must initiate one of the following:
- Obtain their own vehicles in order to provide transportation of their members to/from their SADC program; or
- Contract with a transportation provider for provision of transportation services for their members to/from their SADC program. SADC programs can request a geographic specific list of transportation providers by contacting medtrans@health.ny.gov with the subject line: SADC list of transportation providers.
MLTC plans are still responsible for ensuring that the SADC has appropriately established transportation for all of their members attending the contracted SADC.
Questions should be directed to medtrans@health.ny.gov or 518-473-2160. Plan and provider programs affected by this policy may also convey concerns or questions to LeadingAge NY.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871