F-SHRP Waiver Managed Long Term Care (MLTC) Amendment - August 2012


NUMBER:        11-W-00234/2

TITLE:              Federal-State Health Reform Partnership Medicaid Section 1115 Demonstration

AWARDEE:      New York State Department of Health

All requirements of the Medicaid program expressed in law, regulation, and policy statement, not expressly waived in this list, shall apply to the Demonstration April 1, 2013 through March 31, 2014.

The following waivers of State plan requirements shall enable New York to implement the approved Special Terms and Conditions (STCs) for the New York Federal-State Health Reform Partnership Medicaid Section 1115 Demonstration.

1. Statewideness                                               Section 1902(a)(1)

  • To permit the exclusion of some residents of some counties in New York from participation in Mandatory Mainstream Managed Care (MMMC) and Managed Long Term Care (MLTC) under this Demonstration.

2. Medicaid Eligibility and Quality Control      Section Section1902(a)(4)(A)

  • To enable New York to employ a Medicaid Eligibility and Quality Control System (MEQC) which varies from that required by law and regulation. New York is required to receive annual approval from CMS for its alternative MEQC program.

3. Income Comparability                                    Section 1902(a)(17)

  • To enable New York to apply a more liberal income standard for individuals who are deinstitutionalized and receive community-based long term care services through the managed long term care program than for other individuals receiving community-based long term care.

4. Freedom of Choice                                         Section 1902(a)(23)(A)

  • To enable New York to restrict freedom-of-choice of provider for MMMC and MLTC enrollees, to the extent of the services furnished through those programs. Beneficiaries shall retain freedom of choice of family planning providers.

Demonstration Approval Period: April 1, 2011 through March 31, 2014
Amended August 2012