MLTC Policy 13.04

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.04: Personal Care Contracting Policy

Date of Issuance: February 27, 2013


The following requirements apply to Managed Long Term Care Plans (MLTCPs) with approval to operate in New York City, Nassau, Suffolk and Westchester Counties:

New York City MLTC plans are required to contract with Home Attendant Vendors contracted to the Human Resources Administration (HRA). The MLTC plan must pay the vendor the published rate paid by HRA as of July 1, 2012. There is no requirement for a MLTC plan to contract with a vendor that is not willing to accept the HRA rate.

Nassau, Suffolk and Westchester MLTC plans are required to contract with agencies under contract with Local Social Services Districts (LDSS). The MLTC plan must pay the State published rate paid by the LDSS as of July 1, 2012. There is no requirement for a MLTC plan to contract with an agency that is not willing to accept the State rate.

An enrollee transitioning from fee for service is entitled to the same plan of care and provider for a period of at least 60 days or until a comprehensive assessment is completed, whichever is later. If plan does not have a contract with the provider, then the plan should enter into a single source agreement with that enrollee's provider for the transition period. Such single source agreement may cover up to 10 enrollees. The MLTC plan must pay the rate published by HRA, or the LDSS as of July 1, 2012.

This policy remains in effect until December 31, 2013.