New York State Medicaid Managed Care Alternative Services and Settings - In Lieu of Services (ILS)

New York State, pursuant to federal regulation (42 CFR 438.3(e)), approves cost-effective, medically appropriate, alternatives to regular Medicaid State Plan services included in the Medicaid Managed Care Organization (MMCO) benefit package. These cost-effective alternative services are called "in lieu of services" (ILS).

What you should know about ILS:

  • ILS is only available through Medicaid managed care. Medicaid managed care plans can only offer an ILS if they have the State´s approval.
  • ILS is voluntary. You do not have to use the ILS if you would rather have the regular covered Medicaid service.
  • There can be many different types of services offered as ILS.
  • ILS may be limited to enrollees who meet certain criteria. For example, the ILS may only be available to people who are a specific age or who live in a certain area.
  • ILS may be limited in quantity or duration. For example, you may only be able to get the ILS for 15 days.
  • ILS may be limited to a specific setting. For example, you may only be able to get the ILS if you are in a certain type of hospital. Other ILS may only be an option if you are living at home.
  • The MMCO may decide to stop offering the ILS. The MMCO will send you a notice if this happens.
  • You have the right to a plan appeal and/or State Fair Hearing if you are not happy with a plan decision about your care, including a decision about ILS. See your plan´s member handbook for more information about complaints and appeals.

The following charts list ILS that has been approved by New York State.

The State Approved ILS Provided by Medicaid Managed Care Plans.

  • Chart is also available in XLSX and PDF
State Approved ILS Provided by Medicaid Managed Care Plans
(These ILS were proposed by a Medicaid Managed Care Plan and have been approved by the State as appropriate to offer as a voluntary alternative to covered services.)
Brook+ Diabetes Prevention Program Eligible Population Managed Care Organization/ ILS Authorization Number Plans that Offer this Benefit Service Area
Effective Date: October 1, 2022

Covered ILS Benefit: Brook+ Diabetes Prevention Program

Independent Health will cover Brook+, a Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention program that helps people make lifestyle changes so that they can reduce their risk for type 2 diabetes, achieve a healthy weight, and improve their overall health. The program delivers structured content aligned with CDC recognized in-person NDPP programs. A digital format provides flexibility for participation, while overcoming barriers such as lack of availability of in-person programs, lack of access to in-person programs (due to transportation, for example), or commitments such as work, school, childcare, etc. that might otherwise preclude participation. Moreover, the Brook+ DPP offers convenient on-demand program access through smart devices or web-based delivery, including access to lifestyle coaches that offer unlimited one-to-one support via chat or discussion.
  • Be at least 18 years old, and
  • Be overweight (BMI ≥25, ≥23 if Asian), and
  • Have no previous diagnoses of type 1 or type 2 diabetes, and
  • Not have End Stage Renal Disease (ESRD)
  • Not pregnant, and
  • Have a blood test result in the prediabetes range within the past year:
    • Hemoglobin A1C: 5.7%-6.4%, or
    • Fasting Plasma Glucose: 100-125 mg/dL, or
    • Two-hour plasma glucose (after a 75mg glucose load); 140-199 mg/dL, or
  • Be previously diagnosed with gestational diabetes, or
  • Score 5 or higher on the CDC/ADA Prediabetes Risk Test
 Independent Health Association
(22-02-002)		 MediSource (MMC1)
MediSource Connect (HARP2)		 Erie        

The State Identified ILS Provided by Medicaid Managed Care Plans.

  • Chart is also available in XLSX and PDF
State Identified In Lieu of Services (ILS) for Medicaid Managed Care Plans
(These ILS have been identified by the State as appropriate for Medicaid Managed Care)
Medically Tailored Meals Eligible Population Managed Care Organization/ILS Authorization Number Effective Date* Plans That Offer This Benefit Service Area
Covered ILS Benefit: Medically Tailored meals will be tailored to the medical needs of the recipient by a Registered Dietitian Nutritionist (RDN) and designed to improve health outcomes, lower cost of care, and increase patient satisfaction. This is an alternative service in lieu of Personal care Aide (PCA) service hours used for meal preparation and food shopping, or hospital inpatient stays and/or emergency department visits.

Limitations: Limited to 2 meals/day for six month period, with ability to reauthorize based on member reassessment and need.

Identified MTM Providers Include:
  • God's Love We Deliver
  • The Food Pantries for the Capital District
  • FeedMore of Western New York
  • Mom's Meals
Adults age 18 or older, living with severe illness
Healthplus Health Plan
21-12-001		 April 1, 2022 Empire Blue Cross Blue Shield (MMC1)
Empire Blue Cross Blue Shield (HARP2)		 Bronx Kings New York Queens Richmond
Amida Care
21-12-002		 July 1, 2022 Live Life Plus (HIV SNP3) Bronx Kings New York Queens Richmond
CDPHP
22-02-003		 July 1, 2022 Capital District Physician's Health Plan (MMC1) Capital District Physician's Health Plan (HARP 2) Albany Broome Clinton Columbia Essex
Franklin Fulton Greene Montgomery Rensselaer
Saratoga Schenectady Schoharie Tioga Warren
Washington        
MetroPlus Health Plan
22-03-001		 July 1, 2022 MetroPlus Health Plan (MMC1)
Metroplus Enhanced (HARP 2)		 Bronx Kings New York Queens Richmond
Partnership in Care (HIV SNP3) Bronx Kings New York Queens  
Excellus
22-07-001		 January 1, 2023 Blue Choice Option (MMC1) HMO Blue (MMC1) Blue Option Plus (HARP2) Broome Erie Herkimer Livingston Monroe
Oneida Onondaga Ontario Orleans Otsego
Seneca Wayne Yates    
Independent Health
22-02-001		 January 1, 2023 MediSource (MMC1) MediSource Connect (HARP2) Erie        
Highmark
22-06-002		 January 1, 2023 BlueCross BlueShield of Western New York (MMC1) Allegany Cattaraugus Chautauqua Erie Genesee
Niagara Orleans Wyoming    

*Prior to October 1, 2023, Medicaid Managed Care (MMC) plans were approved to authorize up to 3 meals/day. As of October 1, 2023, per Federal requirements, MMC plans may authorize up to 2 meals/day.


Institution for Mental Disease Eligible Population Managed Care Organization/ILS
Authorization Number		 Plans That Offer This Benefit Service Area
Effective Date: October 1, 2019

Covered ILS Benefit:Inpatient Psychiatric admission in an Institution for Mental Disease (IMD). Short term intensive stay in a private IMD licensed by OMH. This is an alternative setting in lieu of the State Plan Inpatient Psychiatric services available in OMH licensed inpatient units of Article 28 hospitals.

Limitations*:Limited to 0-15 days per calendar month in one of the following six IMD facilities licensed by the Office of Mental Health, if such facility is available in the MMC plan service area:
  • Four Winds Hospital (Westchester County)
  • Four Winds Hospital (Saratoga County)
  • Gracie Square Hospital (New York City)
  • BryLin Hospital (Buffalo)
  • Brunswick Hospital Center (Long Island)
  • South Oaks Hospital (Long Island)

*Note: the Medicaid managed care Benefit Package covers inpatient psychiatric admission to these six facilities up to 30 days per calendar month, up to 60 days per year, which may be authorized as medically necessary after reaching the IMD ILS benefit limit.

The services are generally billed under NYS Medicaid rate code 2858: Private Psychiatric Hospitals; or 2896: ALT Care Day, HRF Level Private Psych Hospital if applicable. Contact the managed care plan for specific billing guidelines.

Adults Age 21-64 needing medicallly necessary care in an acute inpatient psychiatric unit		 Affinity Health Plan
19-09-001		 Affinity Health Plan (MMC1)
Enriched Health (HARP2)		 Bronx Kings Nassau New York Orange
Queens Richmond Rockland Suffolk Westchester
Amida Care
19-09-002		 Live Life Plus (HIV SNP3) Bronx Kings New York Queens Richmond
Capital District Physician´s Health Plan (CDPHP)
19-09-003		 Capital District Physician´s Health Plan (MMC1)
Capital District Physician´s Health Plan (HARP2)		 Albany Broome Clinton Columbia Essex
Franklin Fulton Greene Montgomery Rensselaer
Saratoga Schenectady Schoharie Tioga Warren
Washington        
EmblemHealth (Health Insurance Plan of Greater New York)
19-09-008		 Enhanced Care (MMC1)
Enhanced Care Plus (HARP2)		 Bronx Kings Nassau New York Queens
Richmond Suffolk Westchester    
Excellus Health Plan
19-09-004		 Blue Choice Option (MMC1)
HMO Blue (MMC1)
Blue Option Plus (HARP2)		 Broome Erie Herkimer Livingston Monroe
Oneida Onondaga Ontario Orleans Otsego
Seneca Wayne Yates    
Fidelis Care (New York Quality Healthcare Corporation)
19-09-013		 Fidelis Care (MMC1)
Healthier Life (HARP2)		 Albany Allegany Bronx Broome Cattaraugus
Cayuga Chautauqua Chemung Chenango Clinton
Columbia Cortland Delaware Dutchess Erie
Essex Franklin Fulton Genesee Greene
Hamilton Herkimer Jefferson Kings Lewis
Livingston Madison Monroe Montgomery Nassau
New York Niagara Oneida Onondaga Ontario
Orange Orleans Oswego Otsego Putnam
Queens Rensselaer Richmond Rockland Saratoga
Schenectady Schoharie Schuyler Seneca St. Lawrence
Steuben Suffolk Sullivan Tioga Tompkins
Ulster Warren Washington Wayne Westchester
Wyoming Yates      
HealthFirst PHSP
19-09-005		 HealthFirst PHSP (MMC1)
Personal Wellness Plan (HARP2)		 Bronx Kings Nassau New York Orange
Queens Richmond Rockland Suffolk Sullivan
Westchester        
Highmark
19-09-006		 BlueCross BlueShield of Western New York (MMC1) Allegany Cattaraugus Chautauqua Erie Genesee
Niagara Orleans Wyoming    
HealthPlus Health Plan
19-09-007		 Empire Blue Cross Blue Shield (MMC1)
Empire Blue Cross Blue Shield (HARP2)		 Bronx Dutchess Kings Nassau New York
Orange Putnam Queens Richmond Rockland
Suffolk Ulster Westchester    
Independent Health Association (IHA)
19-09-009		 MediSource (MMC1)
MediSource Connect (HARP 2)		 Erie        
MetroPlus Health Plan
19-09-010		 MetroPlus Health Plan (MMC1)
Metroplus Enhanced (HARP 2)		 Bronx Kings New York Queens Richmond
Partnership in Care (HIV SNP 3) Bronx Kings New York Queens  
Molina Healthcare of New York
19-09-011		 Molina Healthcare of New York (MMC1)
Molina Healthcare Plus (HARP 2)		 Allegany Bronx Broome Cattaraugus Chautauqua
Chenango Cortland Erie Genesee Kings
Livingston Monroe Nassau New York Onondaga
Ontario Orange Orleans Queens Richmond
Rockland Seneca Suffolk Tioga Tompkins
Wayne Westchester Wyoming    
MVP Health Plan
19-09-012		 MVP Health Plan (MMC1)
MVP Harmonious Health Care (HARP2)		 Albany Columbia Dutchess Genesee Greene
Jefferson Lewis Livingston Monroe Oneida
Ontario Orange Putnam Rensselaer Rockland
Saratoga Schenectady Sullivan Ulster Warren
Washington Westchester      
UnitedHealthcare of New York
19-09-014		 UnitedHealthcare Community Plan (MMC1)
Wellness4Me (HARP2)		 Albany Bronx Broome Cayuga Chautauqua
Chemung Chenango Clinton Columbia Dutchess
Erie Essex Franklin Fulton Genesee
Greene Herkimer Jefferson Kings Lewis
Livingston Madison Monroe Nassau New York
Niagara Oneida Onondaga Ontario Orange
Orleans Oswego Queens Rensselaer Richmond
Rockland Schenectady Seneca St. Lawrence Suffolk
Tioga Ulster Warren Wayne Westchester
Wyoming Yates      
VNS Choice
19-09-015		 SelectHealth (HIV SNP3) Bronx Kings New York Queens Nassau
Westchester        
WellCare of New York
19-09-016		 HealthyChoice (MMC1) Albany Bronx Broome Dutchess Erie
Kings Nassau New York Niagara Orange
Queens Rensselaer Richmond Rockland Schenectady
Schuyler Steuben Suffolk Ulster  
YourCare Health Plan
19-09-017		 YourCare Option (MMC1)
YourCare Option Plus (HARP2)		 Allegany Cattaraugus Chautauqua Erie Monroe
Ontario Wyoming      

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