1. 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.

2. MLTC Plan Types Plan Type Abbreviation Description Model Contract Link
Partial LTC Long Term Care: Partial Capitation
LTC Pace Long Term Care: PACE
MA Adv Plus Medicaid/Medicare Advantage Plus
FHP Family Health Plus
SNP Special Needs Plan
Mainstream Medical Assistance
MA Advantage Medicaid/Medicare Advantage
FIDA Fully Integrated Duals Advantage Plan
HARP Health and Recovery PLan

3. Plan Types and Specific Codes (using Fidelis as an example)
Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type GD Fidelis Care at Home (888) Partial LTC (800) YD Fidelis Dual Advantage (718) MA Advantage YF Fidelis Care of NY (877) MA Adv Plus SP NYS Catholic Health Plan, Inc. (Fidelis) Mainstream (800) SP NYS Catholic Health Plan, Inc. (Fidelis) Mainstream

4. 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

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

6. 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

7. PACE – services covered

8. 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

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

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

11. MLTC Medicaid Plan

12. 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

13. Medicaid Advantage Plus Plan

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

15. 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

16. 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

17. 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

18. 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