Managed Long Term Care (MLTC)
What's New
Updated Frequently Asked Questions (FAQ's) document on the Non-Emergency Transportation Carve Out. This service was carved out of MLTC Partial Capitation and MAP Plans effective March 1, 2024.
ATTENTION: NYS SADC HCBS Heightened Scrutiny Submission Available for Public Comment Until May 17, 2024
In compliance with 42 CFR §441.301(c)(5)(v), DOH is pleased to seek submission of comments on its Social Adult Day Care (SADC) Heightened Scrutiny evidence packets, which are required as part of the Statewide Transition Plan (STP) for coming into compliance the Home and Community-Based Services (HCBS) Settings Final Rule for all SADC sites.
The Centers for Medicare and Medicaid Services (CMS) has issued Heightened Scrutiny requirements for HCBS settings presumed to have the qualities of an institution. Settings that fall into one of two categories that define qualities of an institution and are subject to a Heightened Scrutiny review by CMS are as follows:
- Prong 1: Setting is in a publicly or privately operated facility that provides inpatient institutional treatment.
- Prong 2: Setting is in a building on the grounds of, or adjacent to, a public institution.
CMS, based on evidence submitted by the State, will confirm whether a setting is not institutional in nature and does have the qualities of home and community-based settings.
Details on full announcement can be found here: Announcement: NYS SADC Heightened Scrutiny Submission Available for Public Comment Until May 17, 2024 - (Web) - (PDF)
Submission details can be found here: NYS SADC Heightened Scrutiny Submission
MLTC Unwinding from the COVID-19 Public Health Emergency
Resumption of MLTC Involuntary Disenrollments
This guidance applies to Partial Capitation, Medicaid Advantage Plus (MAP), and Programs of All Inclusive Care for the Elderly (PACE) plans.
As the Department returns to regular rules post the Public Health Emergency, this is to announce the release of MLTC Policy 23.03, the Resumption of MLTC Involuntary Disenrollments. Please see the guidance attached and posted here MLTC Policy 23.03: Resumption of MLTC Involuntary Disenrollment Guidance (ny.gov). Packets with required MLTC supporting documentation can be submitted to NYMC for December 1, 2023 involuntary disenrollment effective dates and thereafter.
Please read the instructions contained in MLTC Policy 23.03 Resumption of MLTC Involuntary Disenrollments to ensure your MLTC plan’s understanding and compliance to the MLTC contractual requirements for these resumed involuntary disenrollments. This guidance supersedes the five previous MLTC involuntary disenrollment reasons resumed during the Public Health Emergency.
Please send questions to mltcinfo@health.ny.gov with the subject line: Resumption of MLTC Involuntary Disenrollments. An FAQ document will be forthcoming hereafter.
Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen.
As New York transforms its long-term care system to one that ensures care management for all, enrollment in a MLTC plan may be mandatory or voluntary, depending on individual circumstances.
Enrollment in a MLTC plan is mandatory for those who:
- Are dual eligible (eligible for both Medicaid and Medicare) and over 21 years of age and need community based long-term care services for more than 120 days.
- Reside in the following counties:
- Effective 2012-2013 - NYC, Albany, Erie, Monroe, Nassau, Onondaga, Orange, Rockland, Suffolk & Westchester
- Effective 2014 - Broome, Cayuga, Chenango, Columbia, Cortland, Delaware, Dutchess, Fulton, Genesee, Greene, Herkimer, Livingston, Madison, Montgomery Niagara, Oneida, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, Saratoga, Schenectady Schoharie, Steuben, Sullivan, Tioga, Tompkins, Ulster, Washington, Warren, Wayne, Wyoming
- Effective 2015 - Allegany, Cattaraugus, Chautauqua, Chemung, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, St. Lawrence, Seneca, Schuyler, Yates
Enrollment in MLTC plan is voluntary for those who:
- Are dual eligible and are 18 through 21 years of age and need community based long term care services for more than 120 days and assessed as nursing home eligible.
- Are non-dual eligible and over 18 years of age and are assessed as nursing home eligible.
To learn more about the migration of long-term care services to a managed care environment, click here for the MRT 90 webpage:
- MRT 90
- Medicaid Redesign Team (MRT) II (ny.gov) (additional MLTC Policies)
- Notice of Proposed Settlement of Class Action Concerning Home Care Services Provided Through Senior Health Partners or Healthfirst CompleteCare 10.02.2018
To learn more about the managed long-term care options available, choosing a plan, covered services and enrollee rights, click here:
To see a list of available MLTC plans, click here:
To learn how the different MLTC plans rate, click here:
NYS MLTC Plan Information
Service Authorization, Appeals, and Notices
Health Plan Specific Member Handbook
NYS Model Member Handbooks
- Partial Capitation - (Web) - (PDF)
- Medicaid Advantage (Note: This program ended December 31, 2021.)
- Medicaid Advantage Plus - (Web) - (PDF)
NYS Contracted Health Plan Provider Directories
NYS Contracted Health Plan Ownership and Control Interest Information
NYS Contracted Health Plan Network Adequacy Standards
- Network Adequacy Standards
- To see if a specific provider participates with a specific managed care organization, please visit here.
