MLTC Policy Documents
2023
- MLTC Policy 23.01: PACE Direct Eligibility Process for Medicaid Beneficiaries - 3.3.2023 (PDF)
- Attachment A – Appendix P (PDF)
- Attachment B – PACE Direct Eligibility Disclosure Letter (PDF)
- Attachment C – PACE Direct Eligibility Outcome Letter (PDF)
- Attachment D – MLTC Enrollment Confirmation Notice Plan (PDF)
- Attachment E – Intent to Disenroll Letter (PDF)
- Attachment F – MLTC Involuntary Disenrollment Letter (PDF)
2022
- MLTC Policy 22.03: Behavioral Health Benefits Carve In to Medicaid Advantage Plus (MAP) - 1.1.2023 (PDF) (https://omh.ny.gov/omhweb/bho/docs/guidance-for-mcos-carving-bh-medicaid-advantage-plus.pdf)
- MAP Member Notice - CORE Service Eligibility - (Web) - (PDF)
- 60-Day Notice to the MLTC Plans for BH Carve-in - (Web) - (PDF)
- BH Carve-in Member Notice Template - (Web) - (PDF)
- BH into MAP Member Handbook Insert - (Web) - (PDF)
- NYS MAP Behavioral Billing and Coding Manual - (PDF) - 7.1.2022 (https://omh.ny.gov/omhweb/bho/map-bh-billing-and-coding-manual.pdf)
- OMH Government Rates Table - (XLSX) - (PDF) - 7.1.2022
- Appendix MAP Coding-Taxonomy for BH services - (XLSX) - (PDF) - 7.1.2022
- FINAL BH MAP Billing Webinar FAQs - (Web) - (PDF) - 9.19.2022
- BH into MAP Attestation Updated - (Web) - (PDF) - 7.1.2022
- BH into MAP Readiness Tool v2 - (XLSX) - (PDF) - 9.20.2022
- MLTC Plan and Health Home Collaboration MRT 90 Health Plans, Providers, and Professionals (ny.gov) See Section titled MLTC Plan and Health Home Collaborations - Statewide Documents 2016
- MLTC Policy 22.02: Quality Incentive Vital Access Provider Pool (QIVAPP) 2022-23 Distributions (PDF)
- MLTC Policy 22.01: Implementation of the New York Independent Assessor for Initial Assessments (PDF)
2021
- MLTC Policy 21.06: Changes to Consumer Directed Personal Assistance Program (CDPAP) Regulations (PDF)
- MLTC Policy 21.05 Home and Community Based Services Social Adult Day Care Site Compliance
- HCBS SADC Fact Sheet - (Web) - (PDF) - 12.3.2021
- Announcement: As of 3/1/2023 MLTC Plans No Longer Need to Submit SADC HCBS Self-Assessment Surveys - (PDF) - 02.28.2023
- MLTC SADC HCBS Self-Assessment Tool - (DOCX) - Submission to DOH No Longer Required
- All Plan Meeting slide presentation - (Web) - (PDF) - 11.16.2021.
- HCBS SADC Site Self-Assessment Compliance Webinar - 12.9.2021
- HCBS Compliance Assessment with Guiding Questions for MLTC plan SADC Site Assessors - (PDF) - 12.28.2021
- HCBS SADC Compliance Requirements for MLTC Service Area Expansions and Mergers - (PDF) - 06.30.2022
- HCBS SADC Compliance Verification FAQs - (Web) - (PDF) - 08.11.2022
- SUGGESTED SADC SITE EVALUATION TOOL FOR MLTC PLANS - (XLSX) - (PDF) - Updated 01.10.2023
- Guide for MLTC Plans - (PDF) - Updated 12.21.2022
- Video Tutorials
- Webinar (PDF) - Recording (YouTube) - Transcript (PDF) - 9.16.2022
- FAQs - 10.27.2022
- MLTC Policy 21.04: Managed Long Term Care Partial Capitation Plan Enrollment Lock-In
- MLTC Policy 21.03: Wage Parity Compliance and Certification Guidance
- MLTC Policy 21.03a: Wage Parity Compliance and Certification Guidance - Clarification for Managed Care Organizations
- MLTC Policy 21.02: Implementation of Fiscal Intermediary (FI) Rate Structure
- MLTC Policy 21.01: Transition Policies for Fiscal Intermediaries (FIs) and Consumers under the Consumer Directed Personal Assistance Program (CDPAP)
2020
- MLTC Policy 20.01: Transition policies for fiscal intermediaries (FIs) and consumers under the Consumer Directed Personal Assistance Program (CDPAP) - REMOVED AND REPLACED WITH MLTC POLICY 21.01.
- MLTC Policy 20.02: Moratorium on Managed Long Term Care Partial Capitation Plans
- MLTC Policy 20.03: Non-emergency Transportation in the Consumer Directed Personal Assistance Program
2019
- MLTC Policy 19.02: Clarification of Medicaid provider enrollment provisions for services provided by integrated Medicare/Medicaid Plans (Integrated Plans) through the21st Century Cures Act
2018
- Policy 18.01: Fiscal Intermediary Advertising Review and Approval – 10.22.2018
- Notice of Proposed Settlement of Class Action Concerning Home Care Services Provided Through Senior Health Partners or Healthfirst CompleteCare – 10.02.2018
- Licensed Home Care Services Agencies (LHSCA) Contract Limitation Guidance – 08.17.2018
2017
- MLTC Policy 17.02: MLTC Plan Transition Process – MLTC Market Alteration
2016
- MLTC Policy 16.08: Conflict Free Evaluation and Enrollment Center (CFEEC) Update to Expiration of Evaluations
- MLTC Policy 16.07: Guidance on Task–based Assessment Tools for Personal Care Services and Consumer Directed Personal Assistance Services
- MLTC Policy 16.06: Guidance on Notices Proposing to Reduce or Discontinue Personal Care Services or Consumer Directed Personal Assistance Services
- MLTC Policy 16.05: Non–Emergent Medical Transportation Benefit in MLTC
- MLTC Policy 16.04: Additional Supports Available through Money Follows the Person (MFP)
- MLTC Policy 16.03: CFEEC Dispute Resolution Update
- MLTC Policy 16.02: Statutory Changes for Consumer Directed Personal Assistance Services (CDPAS)
- MLTC Policy 16.01: UAS–NY Assessment Requirements
2015
- MLTC Policy 15.09: Changes to the Regulations for Personal Care Services (PCS) and Consumer Directed Personal Assistance (CDPA)
- Notice of Adoption (PDF, 1.8MB)
- CDPA Changes
- PCS Changes
- MLTC Policy 15.08: Conflict-Free Evaluation and Enrollment Center Dispute Resolution
- MLTC Policy 15.07: Potential Security Exposure UAS
- MLTC Policy 15.06: Nursing Home Transition – Conflict–Free Evaluation and Enrollment Center UAS Requirements
- MLTC Policy 15.05(a): CDPAS FI Questions and Answers
- MLTC Policy 15.05: Clarification on Requirements for Consumer Directed Personal Assistance Service (CDPAS) Fiscal Intermediaries
- MLTC Policy 15.04: Interim Guidance for MLTC Partial Capitation Appeal Notices
- MLTC Policy 15.03: End of Exhaustion Requirement for MLTC Partial Plan Enrollees
- MLTC Policy 15.02: Transition of Medicaid Managed Care to MLTC
- MLTC Policy 15.01(a): REVISED Social Adult Day Care and MLTC: Implementation of New Social Adult Day Care Certification Process
- The correct address for OMIG SADC Registration is: https://apps.omig.ny.gov/sadc/sadccertification.aspx
- Social Adult Day Care (SADC) Certification webinar (WMV, 10MB)
- SADC Certification
- SADC Certification FAQ 5.29.15
- MLTC Policy 15.01: Social Adult Day Care and MLTC: Implementation of New Social Adult Day Care Certification Process
2014
- MLTC Policy 14.08: Paying for Live–In Care Through Personal Care Services and Consumer Directed Personal Assistance Services
- MLTC Policy 14.07: Adult Health Care and Managed Long Term Care Revisions (PDF, 153KB)
- MLTC Policy 14.06: Implementation of the Conflict–Free Evaluation and Enrollment Center (CFEEC)
- MLTC Policy 14.05: Aid–continuing
- MLTC Policy 14.05(a) REVISED: Proper Handling of Enrollees´ Request for Fair Hearing
- MLTC Policy 14.04: MLTCP Potential Enrollee Assessments
- MLTC Policy 14.03: Consumer Directed Personal Assistance Service (CDPAS) and Program of All Inclusive Care for the Elderly (PACE)
- MLTC Policy 14.02: Receipt and Disbursement of Health Recruitment and Retention (HR&R) Funding
- MLTC Policy 14.01: Transfers from Medicaid Managed Care to Managed Long Term Care
2013
- MLTC Policy 13.24(a) UPDATED: Authorization for Release of Protected Health Information (Date of Issuance: 6.1.16)
- MLTC Policy 13.24: Authorization for Release of Protected Health Information
- MLTC Policy 13.23: Coverage of Telehealth Services in MLTC Plans
- MLTC Policy 13.22: Personal Care Contracting Rates
- Personal Care Contracting Policy Rates in Accordance with MLTC Policy 13.22 Effective April 1, 2013
- MLTC Policy 13.22(a): Personal Care Contracting Policy – Rates
- MLTC Policy 13.21: Process Issues Involving the Definition of Community Based Long Term Care
- MLTC Policy 13.20: Provision of DME Supplies Through Pharmacy
- MLTC Policy 13.20 REVISED: Provision of DME Supplies through Pharmacy Reconsidered
- MLTC Policy 13.19: Medicare/Medicaid Coordination of Benefits
- MLTC Policy 13.18: MLTC Guidance on Hospice Coverage
- MLTC Policy 13.18(a): Update MLTC Guidance on Hospice Coverage
- MLTC Policy 13.18(b): MLTC Guidance on Hospice Coverage Update
- MLTC Policy 13.17: Care Management Administrative Services (CMAS) Agreement Guidance
- MLTC Policy 13.17 REVISED: Care Management Protocol Guidelines – applicable to Partial MLTC and MAP plans
- MLTC Policy 13.17A – Q&A Related to 13.17 REVISION: Care Management Protocol Guidelines – applicable to Partial MLTC and MAP plans
- MLTC Policy 13.16: Questions and Answers Further Clarifying the Definition of CBLTC Services
- MLTC Policy 13.15: Refining the Definition of CBLTC Services
- MLTC Policy 13.14: Questions Regarding MLTC Eligibility
- MLTC Policy 13.13: Continuity of Care and Payment Requirements of MLTC Plans to LTHHCP Agencies Providing Care During the 90 Day Transition Period
- MLTC Policy 13.12 REVISED: Personal Care Contracting
- MLTC Policy 13.11: Social Day Care Services Q&A
- MLTC Policy 13.10: Communication with Recipients Seeking Enrollment and Continuity of Care
- MLTC Policy 13.09: Transition of Semi–Annual Assessment of Members to Uniform Assessment System for New York
- MLTC Policy 13.09(a): Transition of Semi–Annual Assessment of Members to Uniform Assessment System for New York
- MLTC Policy 13.09(b): Frequently Asked Questions on Uniform Assessment System for New York
- MLTC Policy 13.08: Reporting Out of County Ancillary Providers on the PNDS
- MLTC Policy 13.07: Private Duty Nursing Summary
- MLTC Policy 13.06: Marketing Guidelines for MLTC Plans and Medical Service Providers
- MLTC Policy 13.05: Social Daycare Services Q&A
- MLTC Policy 13.04: Personal Care Contracting
- MLTC Policy 13.03: CBLTC Definition
- 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)
- MLTC Policy 13.02: MLTC Housing Disregard
- MLTC Policy 13.01: Transition of Care for Fee for Services Participants in Mandatory Counties
- MLTC Policy 13.01 REVISED: Transition of Care for Fee for Services Participants in Mandatory Counties
2012
- Dear Administrator Letter: Plan Notice on Mandatory MLTC, September 20, 2012
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