Managed Long Term Care/Care Coordination Model

The Department has web-posted the applications for new and expanding Managed Long Term Care Plans (MLTCP) consistent with the 2011-2012 enacted budget. and the initiatives of the Medicaid Redesign Team (MRT). Additional MLTCP capacity is needed to meet the requirements of MRT #90 which requires enrollment of individuals 21 and older who require community based long term care services for more than 120 days in a MLTCP or other care coordination model.

These are briefly described as the following:

1. Certificate of Authority Application (COA). This application is to be used by entities that are not currently certified under Article 44 of the Public Health Law. These are entities that are new to managed care. It is similar to an establishment application in that it requires the applicant to provide information on the legal entity that will operate the MLTCP and requires a character and competence review of the board of directors, officers, owners and other controlling persons of the MLTCP among other programmatic requirements.

2. Application for Article 44 Certified Health Plans to Participate in Medicaid Advantage Plus and/or Managed Long Term Care Partial Capitation Plans. This application is to be used by entities that already have a COA to operate another type of managed care plan. This could include plans that are participating in the mainstream Medicaid program. It would also be used by those that have a certificate of authority for MLTCP but want to add another plan type such as a partial cap plan that now wants to do Medicaid Advantage Plus (MAP) or a PACE (that has a COA) that wants to do a partial cap product. (An entity that has a COA that wants to add PACE would complete the PACE application that is available from CMS rather than using a State form.)

3. Service Area Expansion Application. This application is used to apply to expand the service area of an already approved managed care plan to new counties. The application is used by MLTCPs and would be used, for example by a partial capitation plan to expand its approved service area.

4. Care Coordination Model application. This application is to be used by entities that are interested in applying to be considered for a certificate of authority.

All questions regarding these applications should be directed to MLTCAPPS@health.state.ny.us.