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MLTC Market Alterations Policy

The Department of Health (DOH) issued Policy 17.02: MLTC Plan Transition Process – MLTC Market Alteration establishing the processes governing Managed Long Term Care (MLTC) plan closures, consolidations, or service area reductions. The guidance is effective immediately and applies to Partially Capitated MLTC plans, Programs of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP) plans. The policy requires plans to submit a transition plan and seek approval from DOH prior to any action and specifies timeframes for notifying members.

Members of a plan that is discontinuing service will have 60 days to select an alternative plan. The state's enrollment broker will provide information to a transferring member regarding their options and information on which plans include the member's current providers in their networks. Those not selecting a plan will be auto-enrolled into a Partially Capitated plan.

Transferring members will be presumed eligible, and no assessment will be required prior to enrollment. Plans will need to do an assessment within 30 days of transfer unless DOH authorizes a longer timeframe. The existing plan of care will be maintained for 120 days after enrollment or until the plan conducts an assessment and the member agrees to a new plan of care.

In the event of mergers and consolidations, DOH will blend the premium rates of the consolidating plans. When plans close or reduce their service area, DOH will track membership dispersion and adjust rates prior to the regularly scheduled cycle for receiving plans if deemed necessary.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841