Standards for Assessing Need and Determining Amount of Care, Uniform Assessment System Tool (UAS-NY Community Assessment) -- MRT 69, Guidelines for the Provision of Personal Care Services in Medicaid Managed Care, Appeals & Greivances in Managed Long Term Care, Fully Integrated Duals Advantage- Intellectually Developmentally Disabled(FIDA-IDD, Spend-Down or Surplus Income and MLTC - Special Warnings and Procedures, pooled or individual supplemental needs trusts, The Housing Disregard - Higher Income Allowed for Nursing Home or Adult Home Residents to Leave the Nursing Home by Enrolling in MLTC, Approved Long Term Home Health Care Program (, Long Term Home Health Care Waiver Program (LTHHCP) or (Lombardi), Approved Long Term Home Health Care Program (LTHHCP) 1915 (c) Medicaid Waiver Amendment, See below explaining timeline for receiving letter, Updated 2014-2015 MLTC Transition Timeline, Applying for Medicaid Personal Care Services in New York City - BIG CHANGES SEPTEMBER 2012, New York Medicaid Choice (Maximus) Website, Long Term Care CommunityCoalition MLTC page. Southern Tier (Tompkins, Cortland, Tioga, Broome, Chenango, Central (Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison). 438.210(a)(2) and (a) (5)(i). The consumer has several weeks to select a plan, however, the CFEEC will outreach to the consumer after 15 days if no plan is selected. Upon implementation the NYIA will conduct all initial assessments and all routine and non-routine reassessments for individuals seeking personal care and/or Consumer Directed Personal Assistance Services (CDPAS). As the national leader in independent, specialized assessments, we help individuals of all ages with complex needs receive government-sponsored care and supports necessary to improve their quality of life. 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 April 16, 2020(Web)-(PDF)- -Table 5(Be sure to check here to see if the ST&C have been updated). She will have "transition rights," explained here. 42 U.S.C. NYLAG's Guide and Explanation on the CFEEC and MLTC Evaluation Process- while this is no longer a CFEEC, the same tips apply to the NYIA nurseassessment. This means the new plan may authorize fewer hours of care than you received from the previous plan. "ANNOUNCEMENT " LETTER - Important Medicaid Notice-- This "announcement letter" is sent to people with 120 days left on their authorization period for Medicaid personal care, certified home health agency, private duty nursing, CDPAP, and medical model adult day care, or LOmbardi services, telling them "MLTC"is coming letter sent in English and Spanish. UAS-NY Enrollment RN, Per Diem, $140 Per Assessment, Remote (Long Island) Nursing Assessment Services Remote in Long Island, NY +15 locations Up to $840 a day Part-time + 1 Monday to Friday + 3 UAS RN Assessor- MLTC Village Care 3.4 New York, NY 10030 (Harlem area) $87,647 - $98,603 a year Full-time Easily apply TTY: 1-888-329-1541. However, the consumer can go ahead and enroll in the plan while the IRP referral is pending. the enrollee is moving from the plan's service area - see more detail in, hospitalization for greater than 45 days, or. TBI and NHTDW now scheduled for Jan. 1, 2022 (Just extended from 2019 per NYS Budget enacted 4/1/2018). We offer clinical services to children and adolescents with disrupted placements, mental and behavioral healthcare needs, and who require services and supports to thrive within a family-like setting. These plans DO NOT cover most primary and acute medical care. 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. As a result, an MLTC plan could refuse to enroll them -- because they do not have active Medicaid. The chart also includes a5thtype of managed care plan -Medicaid Managed Care -these plans are mandatory for most Medicaid recipients who do NOT have Medicare. 2. 1-800-342-9871. In Sept. 2020 NYLAG submittedextensive commentson the proposed regulations. Unite. On Sept. 4, 2012, the federal government Medicaid agency "CMS" approved the state's request for an "1115 waiver" that will allow NYS to require that alldually eligible (those who have Medicare and Medicaid) adults age 21+ now receiving -- or who will apply for -- community-based long-term care services -- particularlypersonal care/home attendant services,long-termCertified Home Health Agency services, Consumer-Directed Personal Assistance program services (CDPAP), private duty nursing and medical adult day care-- to enroll in a Managed Long-Term Care (MLTC) plan. 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. When you join one of these plans, you give up your original Medicare card or Medicare Advantage card. To schedule an evaluation, call 1-855-222-8350 - the same number used before to request a Conflict Free assessment. The first packets were sent in Manhattan in July 2012, telling them to select a plan by September 2012, later extended to October 2012. 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. Once these two assessments are done, NYIA sends an "Outcome Notice" which says that the consumer is, is not , or may or may not be eligible to enroll in an MLTC plan. 1-888-401-6582 Click here to browse by category. What are the different types of plans? Long-term Certified Home Health Agency (CHHA)services (> 120 days). SEE this article. From children and youth to adults and older adults, we work with individuals representing the entire developmental spectrum. ", http://www.nymedicaidchoice.com/program-materials- NY Medicaid Choice lists - same lists are sent to clients with 60-day Choice letters. (R) Reliable Transportation due to New York travel needs Additional Information Requisition ID: 1000000824 Hiring Range: $63,000-$110,000 Recommended Skills Assessments Clinical Works Communication maximus mltc assessment. New York State, Telephone: If consumer faces DELAYS in scheduling the 2 above assessments, or cannot get an in-person assessment instead of a telehealth one, seeWHERE TO COMPLAIN. All new MLTC plan enrollees must now have a Uniform Assessment System (UAS) entry on record prior to plan enrollment. Services include: State Funded In Home and Community Home Based Care; and Medicaid Waiver for Elderly and Adults with Physical Disabilities; MaineCare Home Health Services, MaineCare Private Duty Nursing Services . 1396b(m)(1)(A)(i); 42 C.F.R. Managed long-term care plan enrollees must be at least age 18, but some require a minimum age of 21. The Department is developing guidance for the MLTCPs in regards to referrals and the 30 day assessment timeframe. How Does Plan Assess My Needs and Amount of Care? All rights reserved. Yes. In 2020 this law was amended to restrict MLTC eligibility -- and eligibility for all personal care and CDPAP services -- to those who need physical assistance with THREE Activities of Daily Living (ADL), unless they have dementia, and are then eligible if they need supervision with TWO ADLs. People who were enrolled in an MLTC plan before Dec. 1, 2020 may still change plans after that date when they choose, but then will be locked in to the new plan for 9 months after the 90th day after enrollment. All languages are spoken. More than simply informing eligibility decisions about benefits, assessments are powerful tools for understanding and successfully addressing the needs and expectations of individual participants. This is the only way to obtain these services for adults who are dually eligible, unless they are exempt or excluded from MLTC. 1-888-401-6582 Service Provider Agreement Addendum Forms. Similarly, CHHA's are prohibited by state regulation from stopping services based on non-payment. Clinical Services | Maximus Clinical Services Timely, accurate, conflict-free screenings and evaluations As the national leader in independent, specialized assessments, we help individuals of all ages with complex needs receive government-sponsored care and supports necessary to improve their quality of life. 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. 1st. On May 2, 2011, Selfhelp Community Services led numerous organizations in submitting these comments, explaining numerous concerns about the expansion of MLTC. B. NYIA is a New York State Medicaid program that conducts assessments to identify your need for community based long term services. A11. home care agency no longer contracts with plan). Can I Choose to Have an Authorized Representative? Posted: 03 May, 2010 by Valerie Bogart (New York Legal Assistance Group), Updated: 24 Jul, 2022 by Valerie Bogart (New York Legal Assistance Group), In addition to this article, for latest updates on MLTC --see this, November 2021 WARNING: See changes in Transition Rights that take effect onNov. 8, 2021, What happens after Transition Period is Over? Persons receiving hospice services (they may not enroll in an MLTC plan, but someone already in an MLTC plan who comes to need hospice services may enroll in hospice without having to disenroll from the MLTC plan. 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. This review is done on paper, not an actual direct assessment. A summary of the comments is on the first few pages of thePDF. The consumer must give providers permission to do this. * Collaborate with member, caregiver, Maximus, and the plan to ensure three-way calls are completed for initial and expedited assessments. Our methodologies are tailored for each state to accommodate unique participation criteria, provider standards, and other measures important to oversight agencies. Agency: Office of Aging and Disability Services (OADS) Maximus has been contracted to partner with the State of Maine Department of Health and Human Services - Office of Aging and Disability Services (OADS) to administer the Supports Intensity Scale for Adults (SIS-A) Assessments, beginning in Mid-Spring 2023. The Department of Health is delaying the implementation of this change in how Medicaid recipients are assessed for personal care and consumer directed personal assistance services, and enrollment into Managed Long Term Care, in recognition of the ongoing issues related to the COVID-19 pandemic, including additional pressures from the current Omicron surge. See Separate articleincluding, After Involuntary Disenrollment seeGrounds for Involuntary Disenrollment- (separate article), The Federal Medicaid statute requires that all managed care plans make services available to the same extent they are available to recipients of fee-for- service Medicaid. This initiative amends the Partnership Plan Medicaid Section 1115 Demonstration waiver to require all dual-eligible individuals (persons in receipt of both Medicare and Medicaid) who are aged 21 or older and are in need of community-based long term care services for more than 120 days to be enrolled into Partial MLTCPs or CCMs. When the Recipient is enrolled with an MLTC, the Recipient and the MLTC will receive an OHIP-0128 MLTC/Recipient Letter indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). See details of the phase in schedule here. The monthly premium that the State pays to the plans "per member per month" is called a "capitation rate." Dont sign up for a new plan unless the new plan confirms that it will approve the services you want and the hours you need. NYLAG Evelyn Frank program webinar on the changes conducted on Sept. 9, 2020 can be viewed here(and downloadthe Powerpoint). For consumers in the hospital that contact the CFEEC for an evaluation, the turnaround time for an evaluation will be shorter due to the acute nature of the situation. Use the Immediate Need procedure to request personal care or CDPAP services from the local DSS/HRA, which can be approved within 1-2 weeks. In August 2012, a letter was sent from The Legal Aid Society, EmpireJustice Center, NYLAG, CIDNY, and other consumer, disability rights and community-based organizations asking for further protections in rolling out MLTC. The amount of this premium is the same for every enrollee, but it is not a cap on the cost of services that any individual enrollee may receive. 18008 Bothell Everett Hwy SE # F, Bothell, WA 98012. 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. 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. Link to federal PACE regs - 42 CFR Part 460.and other guidance on PACE: (2)MEDICAID ADVANTAGE PLUS [MAP] - age requirements vary among plans from 18+ to 65+. The Consumer Directed Personal Assistance Program (CDPAP) is a New York State Medicaid program that allows consumers to recruit, hire, and direct their own care. 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. PHASE 1 - Sept. 2012 inNew York City adult dual eligiblesreceivingMedicaid personal care (home attendant and housekeeping)were "passively enrolled" into MLTC plans, if they did not select one on their own after receiving"60-day letters" from New York Medicaid Choice, giving them 60 days to select a plan. NYLAG submittedextensive commentson the proposed regulations. You may call any plan and request that they send a nurse to assess you and tell you what services they would provide. A1. A15. Maximus is the foremost PASRR authority to help state officers successfully manage every detail of their state's PASRR program and all affiliated long-term care services. Our goal is to make a difference by helping every individual receive the support he or she needs to live a full and rewarding life. Conflict-Free Evaluation and Enrollment Center (CFEEC), Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser, Kings (Brooklyn), Queens, Nassau & Richmond (Staten Island). A dispute resolution process is in place to address this situation. Until 10/1/20, state law authorizesthese services but they are limited to 8 hours per week if that's the only personal care service you need. These concerns include violations of due process in fair hearing appeals. NYS Law and Regulations - New York Public Health Law 4403(f) -- this law was amended by the state in 2011 to authorize the State torequest CMS approval to make MLTC mandatory. A10. The CFEEC will send a nurse to evaluate the patient and ensure they meet the requirements for Managed Long-Term Care (MLTC). 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. Instead, you use your new plan card for ALL of your Medicare and Medicaid services. Enrollment in MLTC, MAP and PACE plans is always effective on the 1st of the month. Use the location bar above to find providers of these services in your area.See the FAQs to learn how to save and organize your results. Under the new regulations, program eligibility requires the need for assistance with three (3) activities of daily living (ADLs) or dementia. These members had Transition Rights when they transferred to the MLTC plan. Sign in. Hamaspik Choice, MLTC. NYIA has its own online Consent Formfor the consumer to sign. Maximus. SOURCE: Special Terms & Conditions, eff. On the Health Care Data page, click on "Plan Changes" in the row of filters. Currently, CFEEC will complete the UAS and provide education to a consumer with a pending Medicaid application. Since this new procedure is new, we have not seen many notices but they are confusing and you might need help deciphering them. The Federal Medicaid statute requires that all managed care plans make services available to the same extent they are available to recipients of fee-for- service Medicaid. Yes. Xtreme Care Staff NY Public Health Law 4403-f, subd. People who were enrolled in an MLTC plan before Dec. 1, 2020 may still change plans after that date when they choose, but then will be locked in to the new plan for 9 months after the 90th day after enrollment. The same law also requires a battery of new assessments for all MLTC applicants and members. When MLTC began, the plans were required to contract with all of the home care agencies and Lombardi programs that had contracts with the local DSS for personal care/ home attendant services, and pay them the same rates paid by the local DSS in July 2012. "TRANSITION RIGHTS" --AFTER YOU are required to ENROLL IN MLTC, the MLTC plan must Continue Past Services for 90 or 120 Days. onsumer Directed Personal Assistance Program (CDPAP), TBI and Nursing Home Transition and Diversion Waiver, WHO DOES NOT HAVE TO ENROLL IN MLTC? As a result, their need for CBLTC could also change and a new evaluation would be required. The capitated payment they receive covers almost all Medicaid services, including personal care and CHHA home health aide services, with some exceptions of services that are not in the benefit package. 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. A summary of the concersn is on the first few pages of thePDF. However, if the MLTC plan determines that a prospective enrolleeneeds more than 12 hours/day on average (generally this means24/7 care)then they must refer it back to NYIA for a third assessment - the Independent Review Panel (IRP)describedbelow. After the 9-month lock-in period ends, enrollees may transfer to another MLTCP at any time for any reason. TBI and NHTDW now scheduled for Jan. 1, 2022 (Just extended from 2019 per NYS Budget enacted 4/1/2018). But consumersl have the option of enrolling in "fully capitated" plans as well -- so it's important to know the differences. Best wishes, Donna Previous When the Recipient is enrolled with an MLTC, the Recipient and the MLTC will receive an OHIP-0128 MLTC/Recipient Letter indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). 2022-06-30; After 120 days of receiving these services, the individual will be required to enroll in an MLTC plan. TTY: 888-329-1541. Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser, the Community Health Assessment (CHA) in the UAS-NY, New Yorks comprehensive assessment for State Plan CBLTSS, conducted by a Registered Nurse; and, a clinical exam, conducted by a clinician on an Independent Practitioner Panel (IPP) under the New York Independent Assessor (NYIA); and. Phase IV (December 2013):Albany, Erie, Onondaga and Monroecounties -See below explaining timeline for receiving letters and getting 60-days to enroll. Bronx location: Please call Maximus at 646.367.5591 or email nycjobs@maximus.com to provide your information. MLTC Enrollment Coordinator Job Ref: 88907 Category: Member Services Department: MANAGED LONG TERM CARE Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Hire In Rate: $50,000.00 Salary Range: $50,000.00 - $57,000.00 Empower. Whenever a Medicaid consumer wants to enroll in Managed Long Term Care (e.g. 438.210(a)(2) and (a) (4)(i). Frank program webinar on the changes conducted on Sept. 9, 2020 can be viewed here ( and Powerpoint. And request that they send a nurse to evaluate the patient and ensure they meet the requirements for long-term! This review is done on paper, not an actual direct assessment only way to obtain these services adults! Services ( > 120 days ) viewed here ( and downloadthe Powerpoint ) you your... Call 1-855-222-8350 - the same Law also requires a battery of new assessments for all MLTC and! Is on the 1st of the month days ) in regards to referrals and 30... 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