DOH has issued a policy update regarding an on-going review of Pharmacy claims which determined that certain Durable Medical Equipment (DME) items were being inappropriately billed as a Pharmacy claim. These billing errors resulted in a fee-for-service payment of items that are included in the capitation payment to Managed Long Term Care Plans (MLTCP).

The purpose of this policy document is to remind Managed Long Term Care (MLTC) plans of the need to effectively coordinate Medicare and other third-party liability benefits for the MLTC dual-eligible membership.  Federal regulations require Medicaid to be the payer of last resort.

This GIS further clarifies MLTC policies as it pertains to Level 1 personal care services as the sole community-based long term care service provided to a consumer.

LeadingAge NY continues to advocate for answers and clarification as this mandatory transition from the LTHHCP to MLTC begins.

DOH has posted a policy on utilizing hospice while in MLTC pursuant to recent changes to Section 4403-f of Article 44 of PHL.

At a June 17 DOH work group meeting, LeadingAge NY and other stakeholders raised questions about the timing and financial aspects of the state’s plan to move certain nursing home residents into Medicaid managed care.

DOH has posted two policies on defining community based long term care services and one on Care Management Administrative Services (CMAS) agreement guidelines. 

The MLTC policy 13:15 further clarifies the definition of community based long term care by stating individuals who only require assistance with housekeeping tasks do not meet the intent of community based long term care services.