LTHHCP, Managed Care and MLTC Policy Updates

LTHHCP – The LTHHCP will close its doors for NEW dual eligibles in the mandatory counties of NYC, Westchester, Nassau and Suffolk counties effective Mon., June 17. As LeadingAge New York previously reported, as of May 15 the LTHHCP was closed to NEW non-duals (Medicaid only) enrollments statewide.

Non-Maximus Counties – DOH has reached out to a couple non-Maximus counties to continue training staff on enrolling the non-dual LTHHCP population.

DOH has hit 100,000 - As of May 1, statewide enrollees in MLTCs was 101,080. For a specific breakdown:

• NYC: partial caps – 86,702, PACE 3,219, Medicaid Advantage Plus 3,767 = 93,688.
• The rest of the state: partial caps – 5,663, PACE 1,550, Medicaid Advantage Plus 179 = 7,392.

New MLTC Policies- Continuity of Care and Eligibility Clarification:

MLTC Policy 13:13 – Continuity of Care and Payment Requirements of MLTC Plans to LTHHCP Agencies Providing Care during the 90 Day Transition Period

Clarifies, as with previous continuity of care policies, LTHHCP individuals transitioning from fee-for-service Medicaid to MLTC must continue to receive services under the enrollee’s pre-existing service plan for at least 90 days after enrollment or until a care assessment has been completed by the Plan, whichever is later. In addition, the patient/worker(s) relationship must be preserved for the same 90 day period. The worker in this case is defined as both professional and paraprofessional staff of the LTHHCP agency.

In this policy it includes the provision that each LTHHCP agency has an agency-specific rate associated with services provided to a LTHHCP participant. Preserving the patient/worker relationship will require MLTC plans to pay the LTHHCP agency their agency-specific fee-for-service Medicaid rate during the 90 day transition period for patients who are mandatorily enrolled into an MLTC.

MLTC Policy 13:14 –Questions Regarding Managed Long Term Care (MLTC) Eligibility

This policy clarifies programmatic eligibility for enrollment into MLTC regarding social day services and next steps when a member no longer needs or accepts the plan services. The later part of this policy covers voluntary and involuntary enrollment for a dual eligible and non-dual eligible members.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871