MLTC Policy 14.05: Aid-Continuing

MLTC Policy 14.05, persuant to Public Health Law Section 4403-f(7)(a)(ii), requires that aid-continuing be provided without regard to the expiration of the MLTC plan's prior service authorization. According to the policy, when a MLTC plan assesses an enrollee and determines to reduce or discontinue previously authorized services, and the enrollee timely files an internal appeal and asks that benefits be continued pending the outcome of the internal appeal, the enrollee is entitled to receive the previously authorized services unchanged pending the outcome of the internal appeal even if the enrollee’s service authorization period has expired.

The policy continues by stating, "when an MLTC enrollee requests a State fair hearing to review a MLTC plan notice of final adverse determination, and the Office of Administrative Hearings of the NYS Office of Temporary and Disability Assistance has issued an aid-continuing directive regarding that enrollee, the MLTC plan must comply promptly with that aid-continuing directive even if the enrollee’s service authorization period has expired. The MLTC plan must comply with the aid-continuing directive until the fair hearing decision is issued."

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