Health Plans, Providers, and Professionals

Interested applicants can find NYS Department of Health managed long term care plan applications and instructions for the programs below at Managed Long Term Care/Care Coordination Model (ny.gov):

  • Medicaid Advantage Plus (MAP)
  • Program for All-Inclusive Care for the Elderly (PACE)
  • MLTC Partial Capitation (no new applications are being accepted effective April 1, 2020 per MLTC Policy 20.02, Moratorium on MLTC Partial Cap Plans).

MLTC Partial Capitation Nursing Home Benefit Limit 3+ Months (NHBL 3+mo): Batch Disenrollment Information

In 2019, the MLTC Partial Capitation (MLTCP) benefit package was changed to limit coverage of long term nursing home stays (LTNHS) to three months and the mandate that dually eligible individuals who are receiving long term nursing home care join an MTLC plan was eliminated. Beginning with enrollments effective February 1, 2020, dually eligible individuals, aged 21 years and older, with an LTNHS designation, are no longer required to enroll in an MLTCP plan.  Individuals with active Medicaid and an LTNHS designation are an excluded population from MLTCP plan enrollment and auto assignment.  Individuals already enrolled in MLTCP plans who have been designated LTNHS and met or exceeded the benefit limitation must be involuntarily disenrolled.  During the COVID-19 Public Health Emergency,  DOH is conducting a "Batch Process" disenrollment three times per year for MLTCP plan enrollees who have been designated LTNHS, have met or exceeded the three month benefit limitation, and who have had their chronic care budgeting (also called institutional budgeting) completed by their Local Department of Social Services (LDSS).

Notices and communications regarding the MLTCP NHBL Batch Disenrollment to enrollees, health plans and nursing homes are below:

NYMC Insert: MLTCP benefit change information for new enrollees (also mailed to all MLTCP enrollees in 2020) - (Web) - (PDF)

Dear Health Plan Administrator Letter: Provided in advance of each Batch Process specifying MLTCP responsibilities. - (Web) - (PDF) - 11.19.21

Dear Nursing Home Administrator Letter: Provided in advance of each Batch Process specifying nursing home responsibilities. - (Web) - (PDF)- 7.23.21

Plan Intent to Disenroll Letter: Mailed to enrollees and their authorized representatives 30 days prior to anticipated disenrollment who have been identified as LTNHS 3+ through DOH, Health Plan and Nursing Home data matching and confirmation. - (Web) - (PDF)

NYMC Disenrollment Letter: Mailed to enrollees and their authorized representatives 10 days prior to their effective date of disenrollment. - (Web) - (PDF)

MLTC Initial Adverse Determination and 4687 MLTC Action Taken Model Notices and Attachments

The Bureau of MLTC has distributed final implementation versions of the Model MLTC Initial Adverse Determination Notice with Appeals Attachment (ver. 04/15) and the 4687 MLTC Action Taken Notice with Fair Hearing Attachment (ver. 04/15). Below are links to the video and slides for the training webinar conducted on April 29, 2015.

  • Medicaid Advantage Plans ending 12/31/2021The Medicaid Advantage plans are ending at the end of 2021 and will no longer will have any members enrolled. Listed below are the template notices that the Medicaid Advantage plans mailed to their members and a copy of the Health Plan Administrator memo sent to the Medicaid Advantage plans outlining wind down activities. Additionally, a copy of the notice sent to UnitedHealthcare Dual Advantage members that had previously disenrolled from their Medicare Advantage plan, has also been attached.
    • Fidelis Care Medicaid Advantage Close-Out Letter - (Web) - (PDF)
    • United Healthcare Medicaid Advantage Close-Out Letter - (Web) - (PDF)
    • WellCare Medicaid Advantage Close-Out Letter - (Web) - (PDF)
    • Dear Administrator Medicaid Advantage Close-Out Letter - (Web) - (PDF)
    • United Health Care Medicaid Advantage Disenrollment Letter - (PDF)
  • MLTC and MMC Letter to Non-Dual Population 5.9.16
    The purpose of this letter is to provide guidance to health plans regarding the transition of non-dual Medicaid Managed Care (MMC) members that have expressed an interest in voluntarily enrolling into a Managed Long Term Care Plan (MLTCP).
  • Request for Information: PACE Model Expansion 3.21.16
    • PACE Model Expansion Questionnaire 3.21.16 (PDF):
      Please download and complete the RFI questionnaire above and save as a PDF document.
      Attach the PDF to an email with the subject "PACE RFI Response" directed to BIP@health.ny.gov.
      Thank you for your thoughtful and detailed responses.
  • Plan Notice on Mandatory MLTC 9.20.12
  • MLTC Partial Plan Additional Rate Codes Letter (August 2014)
  • MLTC Partial Plan Additional Rate Codes Letter (December 2013)
  • Dear Managed Long Term Care HH Collaboration Letter - (Web) - (PDF) - November 13, 2024
  • Guidance for Providing Care Coordination and Management to Medicaid Members Enrolled in MLTC Plans and Health Homes - (Web) - (PDF) - November 2024
  • Statewide Administrative HH Services Agreement between MLTC Partial Capitation and Medicaid Advantage Plus Plans and Health Home - (Web) - November 12, 2024
  • Statewide Administrative Health Home Services Agreement Between MLTC Plan and Health Home Statement and Certification - (PDF)
  • Care Planning and Coordination Form - (PDF) - (XLS) - include MAP 11.01.2024 - November 12, 2024
  • Third Party Confidentiality Attestation for Health Home and MLTCP and MAP plans
    To satisfy the current confidentiality language for third party contract requirements of DOH Privacy and Security, both MLTCP and MAP plans must ensure their contracted Health Homes, which have access to enrollees' Medicaid confidential data, execute the Confidentiality Attestation.
    The completed attestation must be filed with DOH Privacy and Security at: doh.sm.medicaid.data.exchange@health.ny.gov.

Archive

The Recipient Restriction Exception (RRE) Codes are used to identify an individual in active outreach or in receipt of a Medicaid service or program.

The Recipient Restriction Program (RRP) is when an individual's utilization of Medicaid services is considered excessive, following a NYS claims review, the A/R is restricted to only primary providers. The individual is given the opportunity to select which physician, clinic, pharmacy, etc., s/he wishes to use.

Under the brief explanation add three links: and link them to the charts provided.