MLTC Policy 13.15

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.15: Refining the Definition of Community Based Long Term Care Services

Date of Issuance: June 10, 2013


The purpose of this policy is to further clarify the definition of community based long term care. Individuals who only require assistance with housekeeping tasks do not meet the intent of community based long term care services.

Individuals with a need for assistance with both Instrumental Activities of Daily Living (e.g. housekeeping tasks) and Activities of Daily Living (e.g. bathing, grooming, toileting etc) and meeting the eligibility standard of requiring more than 120 days of community based long term care services will continue to be appropriate for MLTC enrollment.

Upon periodic reassessment of MLTC member, whether at six month or 90 days, if it is determined that the member solely requires discrete housekeeping services, they should be considered no longer MLTC eligible and be disenrolled. These individuals should be directed to other community resources for assistance.

Any individuals, not presently in receipt of Personal Care Services or Consumer Directed Personal Assistance Program, who are assessed by the MLTC plan as needing only discrete Level I housekeeping services will no longer meet the threshold for enrolling into MLTC. They should be, as indicated above, directed to other supports.

This action allows the Department to refine our enrollment criteria.