If you know the name of the MLTC plan, tell the nurse and then the nurse can help you arrange the second evaluation with the MLTC plan of your choice. TTY: 1-888-329-1541. Assessments are also integral to the workforce programs we operate worldwide - enabling us to create person-centered career plans that offer greater opportunities for success. 2020 CHANGES in FUNCTIONAL ELIGIBILITY - likely won't be implemented until 2023. which answers questions arising from the scandal in which a NYS Assemblyman was arrested for allegedly taking a bribe from an operator of a social adult day care center. In April 2018, the law was amended to lock-in enrollees into a plan after a 90-day grace period after enrollment. The assessment helps us understand how a person's care needs affect their daily life. Seeenrollment information below. Click here for a self-guided search, Want to explore options? Some parts went into effect on May 16, 2022 and other parts will be phased in over the rest of the year. And see this article for Know Your Rights Fact Sheets and free webinars, November 2021 WARNING: See changes in Transition Rights that take effect onNov. 8, 2021- see separate article here, Lists of Plans - Contact Lists for NYC and Rest of State (MLTC, MAP and PACE). Southern Tier (Tompkins, Cortland, Tioga, Broome, Chenango, Central (Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison). Incentives for Community-Based Services and Supports in Medicaid Managed Long TermCare: Consumer Advocate Recommendations for New York State, elfhelp Community Services led numerous organizations in submitting these comments, Consumer Advocates Call for Further Protections in Medicaid Managed Long Term Care, Greene, Saratoga, Schenectady, and Washington, Dutchess, Montgomery, Broome, Fulton, Schoharie, Chenango, Cortland, Livingston, Ontario, Steuben, Tioga, Tompkins, Wayne, Chautauqua, Chemung, Seneca, Schuyler, Yates, Allegany, Cattaraugus, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, St. Lawrence. Are Functionally eligiible. We deliver gold standard, evidence-based Utilization Review services for a variety of state programs, populations, age groups and diagnoses. Our counselors will be glad to answer your questions. (MLTC). Copyright 2023 Maximus. About health plans: learn the basics, get your questions answered. Yes. The CFEEC contact number is 1-855-222- 8350. Seeenrollment information below. The MLTCplan will now control access to, approve, and pay for all Medicaid home care services and other long-term care services in the MLTC service package. 1396b(m)(1)(A)(i); 42 C.F.R. DOH has proposed to amendstateregulations to implement these changes in the assesment process --regulations areposted here. Maximus Customer Service can be reached by phone and email: . You can also download it, export it or print it out. The details on the Managed Long Term Care expansion request begin at Page 3 of theSummary of MRT changes. If a new enrollee contacts any entity directly, including but not limited to MLTCP's, they should be directed to the CFEEC. List ofLong Term Care Plans in New York City - 3 lists mailed in packet, available online - http://nymedicaidchoice.com/program-materials - NOTE: At this link, do NOT click on the plans listed as "Health Plans" - those are mainstream Medicaid managed care plans that are NOT for people with Medicare. These members had Transition Rights when they transferred to the MLTC plan. Since Houskeeping is for people who are independent with ADLs, this stand-alone service will no longer be authorized for new applicants. As a result, an MLTC plan could refuse to enroll them -- because they do not have active Medicaid. They also approve, manage and pay for the other long-term care services listed below. After such time, a new evaluation will be required if the consumer does not select a plan but continues to seek CBLTC. Acted as key decision-maker for case reviews, leveraging medical, operational, and regulatory acumen to guide approvals on medical plan policies and . See HRA Alert. See, MLTC Roll-Out - Expansion to Nassau, Suffolk & Westchester / and to CHHA, Adult Day Care and Private Duty Nursing in NYC, Dual eligibles age 21+ who need certain community-based long-term care services > 120 days. NOTE - 2013New York Medicaid Choice MLTC Exclusion Formexcludes an individual certified by physician to have a developmental disability. New York Independent Assessor (NYIA) - Through a contract with MAXIMUS Health Services, Inc. (MAXIMUS) the NYIA has been created to conduct independent assessments, provide independent practitioner orders, and perform independent reviews of high needs cases for PCS and CDPAS. A15. Before, the CFEEC could be scheduled with Medicaid pending. After 120 days of receiving these services, the individual will be required to enroll in an MLTC plan. When you change plans voluntarily, even if you have "good cause," you do not have the same right to "continuity of care," also known as "transition rights," that consumers have when they were REQUIRED to enroll in the MLTC plan. SEE this article. If you need more help with enrollment in the Conflict-Free Evaluation Program, feel free to contact Xtreme Care at 718-461-9602 or email us at info@xtcare.com. Maximus Inc4.0 Buffalo, NY 14202(Central Business District area)+14 locations $88,000 - $106,000 a year Full-time Registered Nurse, Telehealth MAXIMUS3.2 Hybrid remote in New York, NY 10004 $95,000 - $100,000 a year Full-time Prior experience using the UAS-NY Community assessmenttool, OASIS or MDS. A summary of the concersn is on the first few pages of thePDF. If those individuals enrolled in a different plan by Oct. 19, 2012, their own selection would trump the auto-assignment, and they would be enrolled in their selected plan as of Nov. 1, 2012. We understand existing recipients will be grandfathered in. Best wishes, Donna Previous 9/2016), at p. 119 of PDF -- Attachment B, NOTE WHICH SERVICES ARE NOT COVERED BY MLTC PARTIALLY CAPITATED PLANS -- but are covered by "fully capitated" Medicaid Advantage Plus or PACE plans, HOW DO PEOPLE IN MLTC Partial Capitation Plans Receive services not covered by the plans? The plan is paid its "capitation" rate or premium on a monthly basis, so enrollment is effective on the 1st of the month. Since this new procedure is new, we have not seen many notices but they are confusing and you might need help deciphering them. To address this problem, HRArecently created a new eligibility code for "provisional"Medicaid coverage for people in this situation. All rights reserved. Programs -will eventually all be required to enroll. Make a list of your providers and have it handy when you call. TBI and NHTDW now scheduled for Jan. 1, 2022 (Just extended from 2019 per NYS Budget enacted 4/1/2018). See. When can you change Plans - New LOCK-IN Rules Scheduled to Start Dec. 1, 2020 -limit right to change plans after 90-day grace period. The 30 day clock begins when the plan is contacted by MAXIMUS and/or the consumer expressing an interest in enrolling. (Exemptions & Exclusions), New York Medicaid Choice MLTC Exclusion Form, MLTC Policy 13.18: MLTC Guidance on Hospice Coverage, MLTC Policy 13.15: Refining the Definition of, MLTC Policy 13.16: Questions and Answers Further Clarifying the Definition of CBLTC Services, MLTC Policy 13.21: Process Issues Involving the Definition of Community Based Long Term Care, Disenrolled Housekeeping Case Consumers (MLTC) 8-13-13.pdf, MLTC Policy 13.11: Social Day Care Services Q&A, Letter from State Medicaid Director Helgerson to MLTC Plans on. Doctors orders (M11q) had not been required. Maximus has been contracted to partner with the State of Maine's Department of Health and Human Services, through the Office of Aging and Disability (OADS), as manager of its Statewide Assessing Services. (Long term care customer services). The organization conducting the evaluations for New York State is not affiliated with any managed care plan, or with any provider of health care or long term care services. This is under the budget amendments enacted 4/1/20. A18. This creates a catch-22, because they cannot start receiving MLTC services until Medicaid is activated. SPEND-DOWN TIP 1 --For this reason, enrollment in pooled or individual supplemental needs trusts is more important than ever to eliminate the spend-down and enable the enrollee to pay their living expenses with income deposited into the trust. If you have any questions regarding this information, please email to the following address: CF.Evaluation.Center@health.ny.gov. See more here. Look for the "Long Term Care" plans for your area - NYC, Long Island, or Hudson Valley. Not enough to enroll in MLTC if only need only day care. This is the only way to obtain these services for adults who are dually eligible, unless they are exempt or excluded from MLTC. The Department has contracted with Maximus Health Services, Inc. (Maximus) to implement the New York Independent Assessor (NYIA), which includes the independent assessment, independent practitioner panel and independent review panel processes, leveraging their existing Conflict Free Evaluation and Enrollment Center (CFEEC) infrastructure and experience. When? Consumers completing plan to plan transfers will not go through the CFEEC as their eligibility for MLTC has already been established. A10. Please consult all previously released materials in conjunction with the following FAQs. See this chart summarizing the differences between the four types of managed care plans described above. to receive home care), they must first receive an assessment by the CFEEC. 1-888-401-6582 MLTC Benefit Package (Partial Capitation) (Plan must cover these services, if deemed medically necessary. 438.210(a)(2) and (a) (5)(i). DOH's regulations draw this line at those needing more than 12 hours/day of home care on average. This change was enacted in the NYS Budget April 2018. maximus mltc assessment. Click on a category in the menu below to learn more about it. A19. The Department of Health and Human Services offers several programs that provide supportive community and facility-based services to older adults and adults with physical disability. We have theexpertise and experience to deliver large-scale assessment programs that alsoensure quality, timely and respectful service is delivered and that the needs of vulnerable individuals are met. Following the CFEEC evaluation, a Department approved notice will be sent to the consumer indicating their eligibility for CBLTC. Applicants who expect to have a spend-down should attach a copy of this Alert to their application and advocate to make sure that their case is properly coded. 1-888-401-6582 As a result, their need for CBLTC could also change and a new evaluation would be required. Contact us Maximus Core Capabilities Long Term Care CommunityCoalition MLTC page includingTransition To Mandatory Managed Long Term Care: The Need for Increased State Oversight - Brief for Policy Makers. However, if they are already enrolled in a mainstream Medicaid managed care plan, they must access personal care, consumer-directed personal assistance, or private duty nursing from the plan. From children and youth to adults and older adults, we work with individuals representing the entire developmental spectrum. This means they arebarred from changing plans for the next 9 months except for good cause. See details of the phase in schedule here. For these plans, your need for daily care must be such that you would be eligible for admission to a nursing home. To schedule an evaluation, call 855-222-8350. A summary of the comments is on the first few pages of thePDF. Make alist of your providers and have it handy when you call. SOURCE: Special Terms & Conditions, eff. Reach them via email: uasny@health.state.ny.us or telephone: 518-408-1021 during regular business hours. 438.210(a) (5)(i). ALP delayed indefinitely. The New York Independent Assessor (NYIA) can help you find out if you qualify for certain long term care services and supports. WHEN - BOTH of the 2 above assessments are SUPPOSED to be scheduled in 14 days. From March, a new company, Maximus, will be taking over that contract. New York State, Telephone: Before, however, enrollment was voluntary, and MLTC was just one option of several types of Medicaid home care one could choose. This criteria will be changing under statutory amendments enacted in the state budget April 2020 (scheduled to be immplemented in Oct. 1, 2020, they will likely not be implemented until 2021). April 16, 2020, , (eff. However, the consumer can go ahead and enroll in the plan while the IRP referral is pending. access_time21 junio, 2022. person. In the event that the disagreement could not be resolved, the matter would be escalated to the New York State Department of Health Medical Director for a final determination within 3 business days. Whether people will have a significant change in their assessment experience remains to be seen. "Managed long-term care" plans are the most familiar and have the most people enrolled. Those already receiving these services begin receiving "Announcement" and then"60-day letters"from New York Medicaid Choice, giving them 60 days to select a plan. Whatever happens at the. TheNYS DOH Model Contract for MLTC Plansalso includes this clause: Managed care organizations may not define covered services more restrictively than the Medicaid Program", You will receive a series of letters from New York Medicaid Choice (www.nymedicaidchoice.com), also known as MAXIMUS, the company hired by New York State to handle MLTC enrollment. this law was amended to restrict MLTC eligibility -- and eligibility for all, Additional resources for MLTSS programs are available in a CMS. See more about MAP in this article.. GOOD CAUSE - EXCEPTION TO LOCK-IN --After the initial 90-day grace period, enrollees will have the ability to disenroll or transfer if NY Medicaid Choice determines they have good cause. Until these changes go into effect, the Plan's nurse conducts the needsassessment using a standardizedUniform Assessment System Tool (UAS-NY Community Assessment) -- MRT 69. The Department has partnered with MAXIMUS to provide all activities related to the CFEEC including initial evaluations to determine if a consumer is eligible for Community Based Long Term Care (CBLTC) for more than 120 days. These changes were scheduled to be implemented Oct. 1, 2020, but have been postponed. TheNYS DOH Model Contract for MLTC Plansstates: Managed care organizations may not define covered services more restrictively than the Medicaid Program." Go through the CFEEC evaluation, a new evaluation will be required if the consumer go. Of home care on average over the rest of the year refuse to enroll in an MLTC plan evaluation! Services and supports manage and pay for the `` Long Term care expansion request begin Page... Adults who are dually eligible, unless they are confusing and you might need help deciphering them be directed the... S care needs affect their daily life directed to the consumer can go and! 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