MLTC – Managed Long Term Care Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen.

MLTC Plan Types Plan Type Abbreviation Description Model Contract Link Partial LTC Long Term Care: Partial Capitation http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/mltc_contract.pdf LTC Pace Long Term Care: PACE http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/pace_model_contract.pdf MA Adv Plus Medicaid/Medicare Advantage Plus http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/map_model_contract.pdf FHP Family Health Plus http://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf SNP Special Needs Plan http://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf Mainstream Medical Assistance http://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf MA Advantage Medicaid/Medicare Advantage http://www.health.state.ny.us/health_care/managed_care/docs/medicaid_advantage_model_contract.pdf FIDA Fully Integrated Duals Advantage Plan https://www.health.ny.gov/health_care/medicaid/redesign/docs/final_three_way_contract_generic.pdf HARP Health and Recovery PLan http://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf

Plan Types and Specific Codes (using Fidelis as an example) Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type GD 01788325 Fidelis Care at Home (888) 343-3547 Partial LTC (800) 695-8544 YD 02738989 Fidelis Dual Advantage (718) 896-6500 MA Advantage YF 02927631 Fidelis Care of NY (877) 533-2404 MA Adv Plus SP 01421250 NYS Catholic Health Plan, Inc. (Fidelis) Mainstream (800) 749-0820 SP 01751046 NYS Catholic Health Plan, Inc. (Fidelis) Mainstream

Mainstream Plans These plans are considered “regular Medicaid plans” Transportation has been carved out and ambulance suppliers bill Fee for Service Medicaid. They are identified by specific codes on EPACES. Ex. Fidelis, Code: SP

Managed Medicaid Plan (Transportation Carved-Out) Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type SP 01751046 NYS Catholic Health Plan, Inc. (Fidelis) (800) 749-0820 Mainstream

PACE Programs: Programs of All Inclusive Care for the Elderly Eligible if 55 years old or older Eligible for nursing home admission Medicare and Medicaid both pay for services at a capitated rate Members must use PACE physicians/providers PACE is responsible for arranging all care Cover all services that are eligible for Medicare and Medicare Primarily Medi/Medi patients

PACE – services covered

Partial LTC Medicaid Long Term Care (can have other insurance primary) Emergency transports billable to Medicaid (if no other insurance primary) Non-emergent, scheduled transports billable to LTC plan with authorization Medicare will auto-cross to Medicaid, Medicaid will deny, billing office must flip payer to the LTC plan for payment

Medicaid Long Term Care - Primary Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type GD 01788325 Fidelis Care at Home (888) 343-3547 Partial LTC

Medicaid Long Term Care - Secondary *Medicare will autocross to Medicaid, Medicaid will deny, and will need to submit to Managed LTC Program.

MLTC Medicaid Plan

MA Advantage Plans (Medicaid Advantage) Medi/Medi plans: members are both Medicare and Medicaid recipients Recipients must enroll in the plans Medicare AND Medicaid plans Medicare plan covers ambulance transportation Medicaid plan covers all home care and transportation to appointments not covered by Medicare

Medicaid Advantage Plus Plan

Managed Medicare & Medicaid (Medi/Medi) Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type YW 02645710 Wellcare of NYM/M (866) 491-5746 MA Advantage

Additional Plans to be aware of! Essential Plans Income between 138% and 200% of Federal Poverty Level Ineligible for Medicaid or Child Health Plus and do not have access to Employer Group HP Age range 19-64 Divided into 2 groups Aliessia – immigrants – premium $0/mo Non-Medicaid – premium $20/mo Covers essential services (emergent) only

Reimbursement of Essential Plans For Alessia members, plan pays Medicaid rate For Non-Alessia members, Affordable Care Act establishes minimum reimbursement amounts that plans must pay Members are held harmless for excess charges by providers DOH discourages plans from paying patients

Other Topics of Importance Prior Authorization Pilot Project - expansion to be delayed for NY and additional states CMS is analyzing the following before expanding the program: Amount of money saved No change in quality of care No change to access to care

Medicare/Medicaid Revalidations Continue to check the CMS Revalidation Look-up Tool for your revalidation date; there will be NO letter from Medicare informing you of revalidation data.cms.gov/revalidation Medicaid will be sending out letters informing providers of their time to revalidate