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Ensuring Maximum Hours with MLTC Evaluations

Individuals receiving home care services through a Managed Long Term Care (MLTC) company may find that the agency did not award their family member or loved one with a sufficient amount of hours of home care services after they’ve conducted an evaluation.

The evaluation process by an MLTC can be complex. A person approved for Medicaid Home Care services will eventually have to enroll with an MLTC. The MLTC provider will send an evaluator to assess the recipient’s condition in order to create a care plan that will suit the individual’s daily needs. The evaluator will determine the number of hours per day that the recipient is entitled to receive to assist with their personal care needs. Continue reading “Ensuring Maximum Hours with MLTC Evaluations”

Expect to Pay More for Home Health and Assisted Living Costs

According to the most recent data from the U.S. Census Bureau, there were 2,797,589 people in New York who were aged 65 and over in 2016 which is 14.6% of the state’s population. Compare that number to 2015, when 2,724,135 seniors lived in New York State (14.3% of the population), and 2014 (2,655,913 people ages 65 and over, 14.0% of the population). Continue reading “Expect to Pay More for Home Health and Assisted Living Costs”

The Care Planning Act of 2015

The U.S. Senate introduced a bill that would allow doctors to be reimbursed by Medicare for providing end of life planning advice to their patients.  This bill is called “The Care Planning Act,” and it would amend title XVIII (Medicare) of the Social Security Act.  This legislation resulted from findings that because Americans are living longer, they are also facing more serious conditions later in life.  The goal of the Act is to ensure that aging individuals with advancing illnesses understand their treatment options and can assist in making their health care choices before losing capacity.  Previously, Medicare would not reimburse qualified health care professionals for this type of counseling.

Continue reading “The Care Planning Act of 2015”

Changes to the Home Care Program

The Budget makes significant changes to New York’s home care program by limiting level 1 personal care services to 8 hours per week and authorizing the Commissioner to set standards for “high-intensity” high-hour personal care services users, pursuant to emergency regulation. Changes in the definition of estate will increase liens and Medicaid recovery actions.

The Budget also mandates enrollment in Managed Long Term Care (or program models that “may” include long term home health care programs) for anyone over age 21 who needs home and community based services ( “as specified by the Commissioner) for more than 120  days. This is likely to be everyone receiving personal care (home attendant), certified home health agency (CHHA) services, and Consumer-Directed Personal Assistance Program services.  Before it becomes mandatory, a federal waiver must be applied for and approved – which is unlikely before the end of 2011 at least.

Persons subject to mandatory enrollment will be assigned to a plan if don’t select one within 30 days of the date on which they are given the choice of plans. Plans are to contract directly with the State Department of Health and perform assessments for their members’ care needs every six months. The role of local districts in assessing and providing long term care is thus significantly reduced.

 

Reprinted from “NY Health Access”