MLTC Policy Documents
2023
- MLTC Policy 23.04: CDPAS Legal Guardian - 10.30.2023
- MLTC Policy 23.03: Resumption of MLTC Involuntary Disenrollment Guidance - 10.18.2023
- MLTC Policy 23.02: Coordination of Hospice - 6.13.2023
- Attachment 1 - Hospice Care Recipient Restriction/Exception (RR/E) Code Update Form (PDF)
- MLTC Policy 23.01: PACE Direct Eligibility Process for Medicaid Beneficiaries - Updated: 6.28.2023
- Attachment A - Appendix P - (Web) - (PDF)
- Attachment B - PACE Direct Eligibility Disclosure Letter - (Web) - (PDF)
- Attachment C - PACE Direct Eligibility Outcome Letter - (Web) - (PDF)
- Attachment D - MLTC Enrollment Confirmation Notice Plan - (Web) - (PDF)
- Attachment E - Intent to Disenroll Letter - (Web) - (PDF)
- Attachment F - MLTC Involuntary Disenrollment Letter - (Web) - (PDF)
- Archive:
- MLTC Policy 23.01: PACE Direct Eligibility Process for Medicaid Beneficiaries - 3.3.2023 (PDF) (See update above: 6.28.23)
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 - (Web) - (PDF) - Updated 4.12.2024 (https://omh.ny.gov/omhweb/bho/map-bh-billing-and-coding-manual.pdf)
- OMH Government Rates Table (Web) - (XLSX) - (PDF) - 7.1.2022
- Appendix MAP Coding-Taxonomy for BH services - (Web) - (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 - (Web) - (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
- MLTC Policy 21.05 Home and Community Based Services Social Adult Day Care Site Compliance
- Announcement: NYS SADC Heightened Scrutiny Submission Avialable for Public Comment Until May 17, 2024 - (Web) - (PDF)
- 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) - 2.28.23
- 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 5.31.2023
- Announcement 8.10.2023: The New York State (NYS) Department of Health (DOH) would like to provide the following reminders to Managed Long Term Care (MLTC) plans, regarding network contracted Social Adult Day Cares (SADCs):
Per MLTC Policy 15.01a, all SADC sites contracted with at least one MLTC plan must certify annually with OMIG. The certification involves the SADC site attesting to compliance with Title 9 NYCRR 6654.20, which establishes minimum requirements for the administration and operation of SADC programs across NYS.- SADC OMIG Registration Form - (External Link)
- NYC Aging SADC Registration - (External Link)
- NYC Aging SADC Homepage - (External Link)
- Announcement: Release of SADC/SADS HCBS Final Rule Compliant PCSP Template - (PDF) - 12.14.2023
- SADC/SADS Person Centered Service Plan Template - (DOCX) - 12.14.2023
- Webinar - 12.7.2023: Overview for MLTC Plans: SADC HCBS Compliance Process - CY2024 HCBS Reviews
- MLTC Policy 21.03a: Wage Parity Compliance and Certification Guidance - Clarification for Managed Care Organizations
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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