Medicaid Redesign

Medicaid Redesign MLTC Policy 13.20: Provision of DME Supplies through Pharmacy: DOH has issued a policy update regarding an on-going review of Pharmacy claims which determined that certain Durable Medical Equipment (DME) items were being inappropriately billed as a Pharmacy claim. These billing errors resulted in a fee-for-service payment of items that are included in the capitation payment to Managed Long Term Care Plans (MLTCP).
11 years ago

Medicaid Redesign MLTC Policy 13.19: Medicare/Medicaid Coordination of Benefits: The purpose of this policy document is to remind Managed Long Term Care (MLTC) plans of the need to effectively coordinate Medicare and other third-party liability benefits for the MLTC dual-eligible membership. Federal regulations require Medicaid to be the payer of last resort.
11 years ago

Medicaid Redesign Transitioning from the LTHHCP to MLTC: LeadingAge NY continues to advocate for answers and clarification as this mandatory transition from the LTHHCP to MLTC begins.
11 years ago

Medicaid Redesign Nursing Home Managed Care Transition Questioned: At a June 17 DOH work group meeting, LeadingAge NY and other stakeholders raised questions about the timing and financial aspects of the state’s plan to move certain nursing home residents into Medicaid managed care.
11 years ago

Medicaid Redesign CDPAS - Final Document Outlining Responsibilities: This final document outlines the roles and responsibilities of the plan and consumer, or designated representative, receiving Consumer Directed Personal Assistance Services (CDPAS).
11 years ago

Medicaid Redesign Level 1 Personal Care Services and Consumer Directed Personal Assistance Services in Managed Long Term Care: This GIS further clarifies MLTC policies as it pertains to Level 1 personal care services as the sole community-based long term care service provided to a consumer.
11 years ago

Medicaid Redesign MLTC Policy 13.18: MLTC Guidance on Hospice Coverage: DOH has posted a policy on utilizing hospice while in MLTC pursuant to recent changes to Section 4403-f of Article 44 of PHL.
11 years ago

Medicaid Redesign DOH Posts Three New MLTC Policies: DOH has posted two policies on defining community based long term care services and one on Care Management Administrative Services (CMAS) agreement guidelines.
11 years ago