MLTC Policy 13.22(a)

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.22(a): Personal Care Contracting Policy - Rates

Date of Issuance: December 5, 2013


The purpose of this policy document is to clarify for Managed Long Term Care Plans (MLTCPs) the required payment rate which must be paid to Personal Care Service providers/agencies servicing MLTCP members.

Previously released MLTC Policies pertaining to Personal Care Contracting have directed MLTCPs with approval to operate in New York City, Nassau, Orange, Rockland, Suffolk and Westchester Counties to contract with Home Attendant Vendors contracted to the Human Resources Administration (HRA) if operating in New York City and/or to contract with agencies under contract with the Local Department of Social Services (LDSSs) if operating those additional counties. MLTCPs were directed to pay the Personal Care Service provider/agency the posted rate by HRA and/or the LDSS, depending on the county of operation, as of July 1, 2012. For HRA, this posted rate includes the Central Insurance Program adjustment but excludes worker recruitment and retention and health benefit adjustments. This policy remains in effect until March 1, 2014.

Plans are to pay the posted HRA/LDSS rate throughout the policy period including any rate changes that may take place during the period. Therefore, whenever the published rate paid by HRA or the LDSSs changes, the MLTCPs must comply with this rate change and pay the newly published rate commencing with the effective date of the change.

Please note that this updated policy directs MLTCPs with approval to operate in the new mandatory districts of Albany, Erie, Monroe, and Onondaga Counties to comply with the requirements; effective until March 1, 2014.