New York State Medicaid Managed Care Alternative Services and Settings - In Lieu of Services (ILS)

New York State, pursuant to federal regulation (42 CFR 438.3(e)), approves cost-effective, medically appropriate, alternatives to regular Medicaid State Plan services included in the Medicaid Managed Care Organization (MMCO) benefit package. These cost-effective alternative services are called "in lieu of services" (ILS).

What you should know about ILS:

  • ILS is only available through Medicaid managed care. Medicaid managed care plans can only offer an ILS if they have the State´s approval.
  • ILS is voluntary. You do not have to use the ILS if you would rather have the regular covered Medicaid service.
  • There can be many different types of services offered as ILS.
  • ILS may be limited to enrollees who meet certain criteria. For example, the ILS may only be available to people who are a specific age or who live in a certain area.
  • ILS may be limited in quantity or duration. For example, you may only be able to get the ILS for 15 days.
  • ILS may be limited to a specific setting. For example, you may only be able to get the ILS if you are in a certain type of hospital. Other ILS may only be an option if you are living at home.
  • The MMCO may decide to stop offering the ILS. The MMCO will send you a notice if this happens.
  • You have the right to a plan appeal and/or State Fair Hearing if you are not happy with a plan decision about your care, including a decision about ILS. See your plan´s member handbook for more information about complaints and appeals.

The following charts list ILS that has been approved by New York State.

The State Approved ILS Provided by Medicaid Managed Care Plans.

  • Chart is also available in XLSX and PDF
State Approved ILS Provided by Medicaid Managed Care Plans
(These ILS were proposed by a Medicaid Managed Care Plan and have been approved by the State as appropriate to offer as a voluntary alternative to covered services.)
Medically Tailored Home-Delivered Meals Eligible
Population
Managed Care Organization/ILS
Authorization Number
Plans That Offer This Benefit Service Area
Effective Date: November 1, 2020

Covered ILS Benefit:
Medically Tailored Meals

Medically Tailored Meals are meals approved by a Registered Dietitian Nutritionist (RDN) of a Medically Tailored Meal provider, based on a nutritional assessment and a referral by a healthcare provider or care coordinator to address medical diagnoses, symptoms, allergies, medication management, and/or side effects, to ensure the best possible health outcomes. Medically Tailored Meals are delivered to the enrollees’ homes or other suitable settings.

Medically Tailored Meals may substitute Personal Care Aide (PCA) services that include time allotted for meal preparation. Members who choose to receive Medically Tailored Meals in lieu of meal preparation hours will incur a reduction in the number of PCA hours they receive for meal preparation.

HCPCS Code S5170 - Home-delivered meals, including preparation; per meal (Homedelivered prepared meal).

Adult members age 18 and older diagnosed with one or more serious or chronic illness(es), are limited in their activities of daily living, and who receive 20 hours or more per week of PCA care that includes some time allotted for meal preparation.
Amida Care
18-08-002
Live Life Plus (HIV SNP) Bronx Kings New York Queens Richmond

The State Identified ILS Provided by Medicaid Managed Care Plans.

  • Chart is also available in PDF
State Identified In Lieu of Services (ILS) for Medicaid Managed Care Plans
(These ILS have been identified by the State as appropriate for Medicaid Managed Care)
Medically Tailored Meals Eligible Population Managed Care Organization/ILS Authorization Number Effective Date Plans That Offer This Benefit Service Area
Covered ILS Benefit: Medically Tailored meals will be tailored to the medical needs of the recipient by a Registered Dietitian Nutritionist (RDN) and designed to improve health outcomes, lower cost of care, and increase patient satisfaction. This is an alternative service in lieu of Personal care Aide (PCA) service hours used for meal preparation and food shopping, or hospital inpatient stays and/or emergency department visits.

Limitations: Limited to 3 meals/day for six month period, with ability to reauthorize based on member reassessment and need.

Identified MTM Providers Include:
  • God's Love We Deliver
  • The Food Pantries for the Capital District
  • FeedMore of Western New York
  • Mom's Meals
Adults age 18 or older, living with severe illness
Healthplus Health Plan
21-12-001
April 1, 2022 Empire Blue Cross Blue Shield (MMC1)
Empire Blue Cross Blue Shield (HARP2)
Bronx Kings New York Queens Richmond
Amida Care
21-12-002
July 1, 2022 Live Life Plus (HIV SNP3) Bronx Kings New York Queens Richmond
CDPHP
22-02-003
July 1, 2022 Capital District Physician's Health Plan (MMC1) Capital District Physician's Health Plan (HARP 2) Albany Broome Clinton Columbia Essex
Franklin Fulton Greene Montgomery Rensselaer
Saratoga Schenectady Schoharie Tioga Warren
Washington        
Independent Health Association (IHA)
22-02-001
July 1, 2022 MediSource (MMC1)
MediSource Connect (HARP2)
Erie        
MetroPlus Health Plan
22-03-001
July 1, 2022 MetroPlus Health Plan (MMC1)
Metroplus Enhanced (HARP 2)
Bronx Kings New York Queens Richmond
Partnership in Care (HIV SNP3) Bronx Kings New York Queens  

Institution for Mental Disease Eligible Population Managed Care Organization/ILS
Authorization Number
Plans That Offer This Benefit Service Area
Effective Date: October 1, 2019

Covered ILS Benefit:Inpatient Psychiatric admission in an Institution for Mental Disease (IMD). Short term intensive stay in a private IMD licensed by OMH. This is an alternative setting in lieu of the State Plan Inpatient Psychiatric services available in OMH licensed inpatient units of Article 28 hospitals.

Limitations*:Limited to 0-15 days per calendar month in one of the following six IMD facilities licensed by the Office of Mental Health, if such facility is available in the MMC plan service area:
  • Four Winds Hospital (Westchester County)
  • Four Winds Hospital (Saratoga County)
  • Gracie Square Hospital (New York City)
  • BryLin Hospital (Buffalo)
  • Brunswick Hospital Center (Long Island)
  • South Oaks Hospital (Long Island)

*Note: the Medicaid managed care Benefit Package covers inpatient psychiatric admission to these six facilities up to 30 days per calendar month, up to 60 days per year, which may be authorized as medically necessary after reaching the IMD ILS benefit limit.

The services are generally billed under NYS Medicaid rate code 2858: Private Psychiatric Hospitals; or 2896: ALT Care Day, HRF Level Private Psych Hospital if applicable. Contact the managed care plan for specific billing guidelines.

Adults Age 21-64 needing medicallly necessary care in an acute inpatient psychiatric unit
Affinity Health Plan
19-09-001
Affinity Health Plan (MMC1)
Enriched Health (HARP2)
Bronx Kings Nassau New York Orange
Queens Richmond Rockland Suffolk Westchester
Amida Care
19-09-002
Live Life Plus (HIV SNP3) Bronx Kings New York Queens Richmond
Capital District Physician´s Health Plan (CDPHP)
19-09-003
Capital District Physician´s Health Plan (MMC1)
Capital District Physician´s Health Plan (HARP2)
Albany Broome Clinton Columbia Essex
Franklin Fulton Greene Montgomery Rensselaer
Saratoga Schenectady Schoharie Tioga Warren
Washington        
EmblemHealth (Health Insurance Plan of Greater New York)
19-09-008
Enhanced Care (MMC1)
Enhanced Care Plus (HARP2)
Bronx Kings Nassau New York Queens
Richmond Suffolk Westchester    
Excellus Health Plan
19-09-004
Blue Choice Option (MMC1)
HMO Blue (MMC1)
Blue Option Plus (HARP2)
Broome Erie Herkimer Livingston Monroe
Oneida Onondaga Ontario Orleans Otsego
Seneca Wayne Yates    
Fidelis Care (New York Quality Healthcare Corporation)
19-09-013
Fidelis Care (MMC1)
Healthier Life (HARP2)
Albany Allegany Bronx Broome Cattaraugus
Cayuga Chautauqua Chemung Chenango Clinton
Columbia Cortland Delaware Dutchess Erie
Essex Franklin Fulton Genesee Greene
Hamilton Herkimer Jefferson Kings Lewis
Livingston Madison Monroe Montgomery Nassau
New York Niagara Oneida Onondaga Ontario
Orange Orleans Oswego Otsego Putnam
Queens Rensselaer Richmond Rockland Saratoga
Schenectady Schoharie Schuyler Seneca St. Lawrence
Steuben Suffolk Sullivan Tioga Tompkins
Ulster Warren Washington Wayne Westchester
Wyoming Yates      
HealthFirst PHSP
19-09-005
HealthFirst PHSP (MMC1)
Personal Wellness Plan (HARP2)
Bronx Kings Nassau New York Orange
Queens Richmond Rockland Suffolk Sullivan
Westchester        
Highmark
19-09-006
BlueCross BlueShield of Western New York (MMC1) Allegany Cattaraugus Chautauqua Erie Genesee
Niagara Orleans Wyoming    
HealthPlus Health Plan
19-09-007
Empire Blue Cross Blue Shield (MMC1)
Empire Blue Cross Blue Shield (HARP2)
Bronx Dutchess Kings Nassau New York
Orange Putnam Queens Richmond Rockland
Suffolk Ulster Westchester    
Independent Health Association (IHA)
19-09-009
MediSource (MMC1)
MediSource Connect (HARP 2)
Erie        
MetroPlus Health Plan
19-09-010
MetroPlus Health Plan (MMC1)
Metroplus Enhanced (HARP 2)
Bronx Kings New York Queens Richmond
Partnership in Care (HIV SNP 3) Bronx Kings New York Queens  
Molina Healthcare of New York
19-09-011
Molina Healthcare of New York (MMC1)
Molina Healthcare Plus (HARP 2)
Allegany Bronx Broome Cattaraugus Chautauqua
Chenango Cortland Erie Genesee Kings
Livingston Monroe Nassau New York Onondaga
Ontario Orange Orleans Queens Richmond
Rockland Seneca Suffolk Tioga Tompkins
Wayne Westchester Wyoming    
MVP Health Plan
19-09-012
MVP Health Plan (MMC1)
MVP Harmonious Health Care (HARP2)
Albany Columbia Dutchess Genesee Greene
Jefferson Lewis Livingston Monroe Oneida
Ontario Orange Putnam Rensselaer Rockland
Saratoga Schenectady Sullivan Ulster Warren
Washington Westchester      
UnitedHealthcare of New York
19-09-014
UnitedHealthcare Community Plan (MMC1)
Wellness4Me (HARP2)
Albany Bronx Broome Cayuga Chautauqua
Chemung Chenango Clinton Columbia Dutchess
Erie Essex Franklin Fulton Genesee
Greene Herkimer Jefferson Kings Lewis
Livingston Madison Monroe Nassau New York
Niagara Oneida Onondaga Ontario Orange
Orleans Oswego Queens Rensselaer Richmond
Rockland Schenectady Seneca St. Lawrence Suffolk
Tioga Ulster Warren Wayne Westchester
Wyoming Yates      
VNS Choice
19-09-015
SelectHealth (HIV SNP3) Bronx Kings New York Queens Nassau
Westchester        
WellCare of New York
19-09-016
HealthyChoice (MMC1) Albany Bronx Broome Dutchess Erie
Kings Nassau New York Niagara Orange
Queens Rensselaer Richmond Rockland Schenectady
Schuyler Steuben Suffolk Ulster  
YourCare Health Plan
19-09-017
YourCare Option (MMC1)
YourCare Option Plus (HARP2)
Allegany Cattaraugus Chautauqua Erie Monroe
Ontario Wyoming      

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