Revised Personal Care Contracting Policy

DOH had previously issued an MLTC policy on personal care contracting as the first counties went to mandatory enrollment (NYC, Nassau, Suffolk and Westchester). DOH has just revised this policy and extends similar provisions to the next counties to go mandatory, Orange and Rockland. MLTCs are still required to contract with agencies that have contracts with LDSSs and pay the same published rate. This policy is in effect from June 1 through Dec. 31, 2013 and also includes the new 90-day continuity of care provision as follows:

"An enrollee transitioning from fee-for-service is entitled to the same plan of care for a period of at least 90 days or until a comprehensive assessment is completed, whichever is later. Efforts should also be made to preserve the same enrollee/worker relationship for the 90 day period. If a plan does not have a contract with the provider, then the plan should enter into a single source agreement with that enrollee’s provider for the transition period. Such single source agreement may cover up to 10 enrollees. The MLTC plan must pay the rate published by the LDSS as of July 1, 2012."

We have asked DOH to define, "same enrollee/worker relationship" as to which job categories are included and will advise members accordingly.

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