Residential Facility Clarification

The Involuntary Disenrollment Guidance (MLTC 23.03) requires disenrollment of individuals who enter an OMH, OPWDD, OASAS residential program or state-operated psychiatric center for forty-five (45) consecutive days or more if that service is not an MLTC covered benefit. The reason for disenrollment is "applicable to all MLTC plan types."

The following are services are covered MAP benefits, and, thus, involuntary disenrollment does not apply to these services:

  1. OASAS Residential Rehabilitation
  2. OASAS Residential Medically Supervised Withdrawal and Stabilization
  3. Part 820 Residential Services - with three elements:  Stabilization, Rehabilitation, and Reintegration
  4. OMH Crisis Residence
  5. OMH CPEP Extended Observation Bed

In addition, the MAP Billing Guidance will be updated to reflect the following guidance about OMH Residences:

MAP enrollees admitted to the following inpatient/residential programs are no longer eligible for Medicaid managed care and will be disenrolled from MAP:

  1. OMH Residential Treatment Facilities
  2. OMH State-operated Community Residences
  3. OMH State-operated Psychiatric Centers

*Article 28 and 31 inpatient services are still covered by the MAP plan per the MAP Model Contract.

Entry into an OMH, OPWDD, or OASAS residential program of any type would require that the Partial Capitation or PACE plan submit an involuntary disenrollment if the Enrollee has been admitted for forty-five (45) consecutive days or longer from the effective date of this policy.

MAP plans must submit an involuntary disenrollment request if the Enrollee has been admitted to non-MAP plan covered facility/program for forty-five (45) consecutive days or longer from the effective date of this policy.