On the Health Care Data page, click on "Plan Changes" in the row of filters. SPEND-DOWN TIP 2 - for new applicants who will have a Spend-Down - Request Provisional Medicaid Coverage -- When someone applies for Medicaid and is determined to have a spend-down or "excess income," Medicaid coverage does not become effective until they submit medical bills that meet the spend-down, according to complicated rules explained here and on the State's website. MLTC Policy 13.05: Social Daycare Services Q&A, MLTC Policy 13.15: Refining the Definition of CBLTC Services, MLTC Policy 13.14: Questions Regarding MLTC Eligibility, Medicaid Buy-In for Working People with Disabilities (, https://www.health.ny.gov/health_care/medicaid/redesign/nyia/, NYLAG's Guide and Explanation on the CFEEC and MLTC Evaluation Process, Consumer Directed Personal Assistance Program, ENROLLMENT: What letters are sent in newly mandatory counties to people receiving Medicaid home care services through county, CHHA, etc -- 60 days to choose MLTC PLAN, PowerPoint explaining Maximus/NYMedicaid Choice's role in MLTC, Form Letter to Personal Care/Home Attendant recipients, http://nymedicaidchoice.com/program-materials, B. Chapter 56 of the Laws of 2020 authorized the Department of Health (Department) to contract with an entity to conduct an independent assessment process for individuals seeking Community Based Long Term Services and Supports (CBLTSS), including Personal Care Services (PCS) and Consumer Directed Personal Care Services (CDPAS or CDPC Program CDPAP). Once you are enrolled in a MLTC plan, you may no longer use your Medicaid card for any of these services, and you must use providers in the MLTC plans network for all of these services, including your dentist. New York Medicaid Choice is the managed care enrollment program of the New York State Department of Health. A10. The plan and enrollee agree that the transfer is appropriate and would be in the best interest of the enrollee. Furthermore, the CFEEC evaluation will only remain valid for 60 days. This creates a catch-22, because they cannot start receiving MLTC services until Medicaid is activated. 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). 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. Managed long-term care plan enrollees must be at least age 18, but some require a minimum age of 21. ", http://www.nymedicaidchoice.com/program-materials- NY Medicaid Choice lists - same lists are sent to clients with 60-day Choice letters. The Packet includes: Form Letter to Personal Care/Home Attendant recipients (at this link with sample envelope) -- It also includes the toll-free number of the enrollment broker, NY Medicaid Choice, for consumers to call with questions about MLTC and help picking a plan..: 888-401-6582. for high needs cases, defined as the first time, after the date of NYIA implementation, the proposed plan of care includes services for more than 12 hours per day, on average, an Independent Review Panel (IRP) evaluation to ensure that the proposed Plan of Care developed by the Local Department of Social Services (LDSS) or the Medicaid Managed Care Organization (MMCO) is appropriate and reasonable to maintain the individuals safety in their home. This additional time will allow DOH to continue to engage with Medicaid managed care organizations, local departments of social services and other stakeholders to ensure the smoothest transition possible. The CFEEC is administered by Maximus, NY State's vendor, also known as NY Medicaid Choice. 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. 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. They provide Medicaid long-term care services (like home health, adult day care, and nursing home care) and ancillary and ambulatory services (including dentistry, optometry, audiology, podiatry, eyeglasses, and durable medical equipment and supplies), and receive Medicaid payment only, with NO Medicare coverage. Click here for a keyword search, Need help finding the right services? See more here. A19. Maximus serves as a contractor in three regions under the UK's Work Programme initiative. All languages are spoken. 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. As a result, their need for CBLTC could also change and a new evaluation would be required. 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? WHERE - the 2 assessments above must be conductedin the home, hospital or nursing home, but also can be done by telehealth. 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. WHY - NYIA was authorized by the FY 2020 NYS Budget, upon recommendation of the NYS Medicaid Redesign Team 2 The State wanted an "independent physician" to determine eligibility, rather than the consumer's physician, who the State apparently believed was biased. The tentative schedule is as follows: Yes. Whatever happens at the. It does not state that they have to enroll yet.. just says that it is coming and to expect a letter. Again, this is a panel run by New York Medicaid Choice. The CFEEC UAS will be completed electronically. The providers will be paid by the MLTC plan, rather than billing Medicaid directly. 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. NOTE:MEDICAID ADVANTAGE PLANS are a slight variation on the MEDICAID ADVANTAGE PLUS plans. From March, a new company, Maximus, will be taking over that contract. 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. The same law also requires a battery of new assessments for all MLTC applicants and members. WHEN - BOTH of the 2 above assessments are SUPPOSED to be scheduled in 14 days. While the State's policy of permitting such disenrollment is questionable given that federal law requires only that medical expenses be incurred, and not paid, to meet the spend-down (42 CFR 435.831(d)), the State's policy and contracts now allow this disenrollment. Call 1-888-401-6582. They then will be locked in to that plan for nine months after the end of their grace period. Mainstream plans for those without Medicare already had a lock-in restriction. 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. 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. NYIA is a New York State Medicaid program that conducts assessments to identify your need for community based long term services. Click on a category in the menu below to learn more about it. kankakee daily journal obituaries. By mid-2021, the State will develop a "tasking tool" for MLTC plans to develop a plan of care based on the UAS assessment. Those changes restrict eligibility for personal care to people who need assistance with ADLs. TBI and NHTDW now scheduled for Jan. 1, 2022 (Just extended from 2019 per NYS Budget enacted 4/1/2018). 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. (State directed MLTC plans to disenroll these individuals and transition them back to DSS). All rights reserved. A15. the enrollee was absent from the service area for more than 30 consecutive days. A18. The Guided Search helps you find long term services and supports in your area. A summary of the concersn is on the first few pages of thePDF. Must not be"exempt" or "excluded" from enrolling in an MLTC plan. Must request a Conflict-Free Eligibility assessment. maximus mltc assessment. Company reviews. Website maximus mltc assessment 1396b(m)(1)(A)(i); 42 C.F.R. 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. These concerns include violations of due process in fair hearing appeals. 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 Reside in the counties of NYC, Nassau, Suffolk or Westchester. JUNE 17, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date. Counselors will ask if you want to join a plan that works with the home care agency or other provider you have now. NYIA is a New York State Medicaid program that conducts assessments to identify your need for community based long term services. More than simply informing eligibility decisions about benefits, assessments are powerful tools for understanding and successfully addressing the needs and expectations of individual participants. The rate is supposed to be enough for the plan to save money on members who need few services, so that it can provide more services to those who need more care. SOURCE: Special Terms & Conditions, eff. Among the government agencies we support are Medicaid, Department of Health, and Child Welfare. People who receive or need ONLY "Housekeeping" services ("Personal Care Level I" services under 18 NYCRR 505.14(a)). WARNING ABOUT CHANGING PLANS during 90-day "grace period" or for Good Cause - NO TRANSITION RIGHTS: 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. Questions can be sent to independent.assessor@health.ny.gov. Southern Tier (Tompkins, Cortland, Tioga, Broome, Chenango, Central (Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison). No. Maximus is currently hiring for Registered Nurse (RN) Quality Assurance Specialists to support the New York Independant Assessor Program (NYIA). On May 2, 2011, Selfhelp Community Services led numerous organizations in submitting these comments, explaining numerous concerns about the expansion of MLTC. 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. The 2020 state changes, once implemented, will change the assessment process: The UAS Nurse assessment will be conducted by a nurse from NY Medicaid Choice, not by the Plan. Are conducted by an independent organization, Maximus To determine eligibility for MLTC Are valid for 60 days. In addition to these changes, effective November 8, 2021, the regulations expanded the type of clinicians that may sign a Practitioners Order for PCS/CDPAS and conduct a high-needs case review to include: As of November 8, 2021, the regulations also increased the length of time the CHA may be valid from six (6) months to up to twelve (12) months. 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. As a plan member, you are free to keep seeing your Medicare or Medicare Advantage doctor and other providers of services not covered by your plan. There are 2 types of FULL CAPITATION plans that cover Medcaid long-term care: (1) PACE"Programs of All-Inclusive Care for the Elderly" plans - must be age 55+ SeeCMSPACE Manual. MANDATORYENROLLMENT PACKET - Sent by NY Medicaid Choice 30 days after the 1st "announcement" letter - stating recipient has 60 days to select a plan ORwill be assigned to anMLTC plan. If you enrolled late in the month (after the third Friday of the month), the enrollment will not be effective -- and the new plan will not take charge of your care -- until the first of the second month after you enroll. After 120 days of receiving these services, the individual will be required to enroll in an MLTC plan. The New York Independent Assessor (NYIA) can help you find out if you qualify for certain long term care services and supports. Is there a need for help with any of the following: First, let's name the new folder you'll be adding your favorites to, Address: GIS 22 MA/05 and Mainstream MC Guidance were posted on June 17, 2022 to delay implementation of the NYIA conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to October 1, 2022. 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. The new NYIA process to enroll in an MLTC has TWO instead of only ONE assessments: Independent Practioner Panel (IPP) or Clinical Assessment (CA). While no formal referral process exists, providers should redirect consumers to the CFEEC by providing contact information. Must request a Conflict-Free Eligibility assessment. These plans DO NOT cover most primary and acute medical care. A1. There may be certain situations where you need to unenroll from MLTC. To make it more confusing, there are two general types of plans, based on what services the capitation rate is intended to cover: I. You will still have til the third Friday of that month to select his/her own plan. (Note NHTW and TBI waivers will be merged into MLTC in January 1, 2022, extended from 2019 per NYS Budget enacted 4/1/2018). 2016 - 20204 years. onsumer Directed Personal Assistance Program (CDPAP), TBI and Nursing Home Transition and Diversion Waiver, WHO DOES NOT HAVE TO ENROLL IN MLTC? If the consumer agrees to this plan of care, she can enroll. Improve health outcomes in today's complex world, Modernize government to serve the needs of citizens, Empower vulnerable populations to succeed, Meet expectations for service and ease of use, Leverage tax credits, recruit and retain qualified workers, Provide conflict-free health screenings and evaluations, Resolve benefit disputes with a nonjudicial approach, Modernize your program, adapt to changing needs, Make services easier to access, ensure program integrity, Creating a positive impact where we live and work, Recognized by industry and media for making an impact. PACE and Medicaid Advantage Plus plans provide ALL Medicare and Medicaid services in one plan, including primary, acute and long-term care. 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. They provide and control access to all primary medical care paid for by MEDICARE and MEDICAID, EXCEPT that they do not cover mostlong-term care services by either Medicaid or Medicare. See model contract p. 15 Article V, Section D. 5(b). 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. This is explained in this Medicaid Alert dated July 12, 2012. Best wishes, Donna Previous 10 Reliability Initiative CFE and MLTC assessment on the same person within 60 days were compared Evaluated NFLOC, and the 11 components and 22 UAS-NY items that . Not enough to enroll in MLTC if only need only day care. Since this new procedure is new, we have not seen many notices but they are confusing and you might need help deciphering them. You can also download it, export it or print it out. Click here for a keyword search Need help finding the right services? Plans will retain the ability to involuntarily disenroll for the reasons specified in their contract, which includes: After the completion of the lock-in period, an enrollee may transfer without cause, but is subject to a grace period and subsequent lock-in as of the first day of enrollment with the new MLTC partial capitation plan. The assessment helps us understand how a person's care needs affect their daily life. 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. "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. Exists, providers should redirect consumers to the CFEEC by providing contact information yet.. just that... Below to learn more about it required to enroll in MLTC if only need only day care administered! Was absent from the service area for more than 30 consecutive days from March, a new York Assessor! Deciphering them need to unenroll from MLTC a lock-in restriction they can not start receiving MLTC services Medicaid. 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