MLTC Policy 16.03

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Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 16.03: Conflict Free Evaluation and Enrollment Center (CFEEC) Dispute Resolution Policy-UPDATE

Date of Issuance: June 1, 2016

The purpose of this policy is to provide additional clarification on MLTC Policy 15.08 to the Managed Long Term Care Plans (MLTCPs) should there be a disagreement on the consumer´s eligibility for Community Based Long Term Care (CBLTC) services. Additionally, this policy seeks to clarify when the dispute resolution process for CFEEC should be initiated.

The dispute resolution process was created as a mechanism to identify discrepancies between the CFEEC evaluation determination and the MLTCP assessment regarding CBLTC eligibility. MLTC Policy 15.08 describes this process and explains how this process exists when the selected plan disagrees with the CFEEC´s determination of CBLTC eligibility.

The dispute resolution process should not be initiated if the MLTCP chooses to deny enrollments for other reasons, e.g. health and safety. In cases such as these, plans need to advance their denial to New York Medicaid Choice to initiate the Plan Enrollment Denial Process.

If you have any questions regarding this information, please email to the following address: CF.Evaluation.Center@health.ny.gov.