New DOH Policy Allows MLTC Members on Hospice to Change Plans

The State Department of Health has issued new guidance authorizing managed long term care (MLTC) plan members who are receiving hospice benefits to change to a different MLTC plan and continue to receive hospice services. Under previously-issued guidance (MLTC 13.18), Medicaid fee-for-service beneficiaries in receipt of hospice services were excluded from enrollment in MLTC plans.  However, MLTC 13.18 permitted beneficiaries enrolled in MLTC plans to elect to receive hospice services, without disenrolling from their MLTC plan.  The new policy (MLTC 13.18(a)) allows MLTC members to transfer from one plan to another without losing access to hospice benefits.  As an example of a situation in which such a transfer would be appropriate, the policy describes an MLTC member who is admitted to an out-of-network nursing home for post-acute rehabilitation, elects hospice, and requires permanent placement.  Instead of moving to another nursing home for his or her permanent placement, the member would be permitted to transfer to another MLTC plan that contracts with his/her current nursing home.

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383, ext. 124.