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 chart lists ILS that has been approved by New York State.

  • Chart is also available in XLSX and 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)
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, Suffolk, Sullivan, Westchester
HealthNow New York
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, Kings, Nassau, New York, Putnam, Queens, Richmond
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)
Broome, Chenango, Cortland, Onondaga, Tioga, Tompkins
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

1. Medicaid Managed Care  1
2. Health and Recovery Plan  2
3. HIV Special Needs Plan  3