MLTC Policy 13.16:
Questions and Answers Further Clarifying the Definition of CBLTC Services
- Policy is also available in Portable Document Format (PDF)
Office of Health Insurance Programs
Division of Long Term Care
MLTC Policy 13.16: Questions and Answers Further Clarifying the Definition of Community Based Long Term Care Services
Date of Issuance: June 11, 2013
The purpose of this release is to clarify the Department´s recent policy directive concerning refining the definition of community based long term care services, Policy 13.15: Refining the Definition of Community Based Long Term Care Services. Some MLTC plans have sought greater clarification from the Department as a result of the change to the CBLTC services definition.
Q. Are there transition cases in which the Consumer Directed Personal Assistance Program services are limited to housekeeping tasks?
A. Yes, there are some CDPAP participants who are solely in need of housekeeping tasks. This support cannot exceed 8 hours per week of care.
Q. Will CDPAP cases be eliminated from the systemic transition cases in the mandatory counties in the near future?
A. CDPAP is a bundled service which may include personal care services (including housekeeping), home health aide and skilled nursing services therefore it is not possible to systemically remove housekeeping tasks from the transition sweep. Plans will have to conduct assessments to determine the scope of services required by an individual and follow the instructions contained in Policy 13.15: Refining the Definition of Community Based Long Term Care Services if discrete housekeeping services are the sole service identified.
Q. Should MLTCs be discharging individuals at time of the 6 month assessment if assessed need is solely for housekeeping?
A. Yes, if an individual at time of reassessment requires only discrete housekeeping services, they should be considered no longer appropriate for MLTC enrollment and be disenrolled. Appropriate referrals should be made to community supports or the local social services district.
Q. How do we handle an individual who was transitioned to MLTC, an assessment is conducted within 30 days and it is determined that the sole need of the individual is solely for housekeeping tasks?
A. If an MLTC plan determines at time of initial assessment that an individual is solely in need of housekeeping services, they should indicate to the individual that they will continue to receive the same services for up to 90 days but after that time will continue to receive their care through the fee for services Personal Care Services Program. The plan should work with the individual to assure they will continue to receive services at the end of 90 days through the local social services district. This will be considered a voluntary disenrollment.
