MLTC Policy 13.03(A)

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.03(A): Definition of Community Based Long Term Care (CBLTC) Services, Applicability to Program of All Inclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP)

Date of Issuance: October 8, 2013


The purpose of this document is to address questions and concerns that have been expressed regarding the application of MLTC Policy 13.03, Definition of Community Based Long Term Care (CBLTC) Services, to the Program of All Inclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP).

Managed Long Term Care (MLTC) Policy documents are directed, as applicable, to all three product lines with operating authority pursuant to Article 4403-f, under the rubric of MLTC: Partially Capitated Medicaid Plans, Medicaid Advantage Plus (MAP) Plans, and PACE.

The Department has repeatedly communicated with MLTC Plans and other stakeholders with regard to the definition of CBLTC Services as a primary condition of eligibility for enrollment in a Managed Long Term Care plan. Consumers must demonstrate need for CBLTC Services for more than 120 days, and these services are defined as: Nursing Services in the home, Home Health Care (which is further defined as traditional Certified Home Health Agency (CHHA) services such as therapies or home health aide service in the home), Personal Care Services in the home (excluding Level 1), Consumer Directed Personal Assistance Services, Adult Day Health Care (ADHC), and Private Duty Nursing.

The demonstrated need for CBLTC Services for more than 120 days is the baseline requirement for enrollment in a Partially Capitated Plan, Nursing Home Level of Care is an additional condition of enrollment that is required for both the PACE and MAP products.

The PACE Model is designed around the PACE Center, where consumers receive medical services such as physician, nursing, and therapies; in addition to socialization, recreation therapy, meals and personal care. Although the PACE Centers are not licensed as an ADHC, the medical components provided at the Center under Article 28 Diagnostic and Treatment Center licensure are the equivalent to need for ADHC as per the definition of CBLTC Services.

Please note that this definition is applicable on a Statewide basis to MLTC Partial Cap, Medicaid Advantage Plus, and PACE plans.