Long-Term Services and Supports (MyCare)
See the following table for transition requirements.
Waiver Consumers:
90 days for individuals identified for high-risk care management
365 days for all others
Non-Waiver Consumers with LTC Needs (HH and PDN use):
90 days for individuals identified for high-risk care management
365 days for all others
NF Consumers
AL Consumers:
90 days for individuals identified for high-risk care management
365 days for all others
No LTC Need Consumers:
90 days for individuals identified for high-risk care management
365 days for all others
Waiver Consumers:
90 days
Non-Waiver Consumers with LTC Needs (HH and PDN use):
90 days
NF Consumers
AL Consumers:
90 days
No LTC Need Consumers:
90 days
Waiver Consumers:
Must honor prior authorizations (PAs) when item has not been delivered and must review ongoing PAs for medical necessity
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Must honor prior authorizations (PAs) when item has not been delivered and must review ongoing PAs for medical necessity
NF Consumers
AL Consumers:
Must honor prior authorizations (PAs) when item has not been delivered and must review ongoing PAs for medical necessity
No LTC Need Consumers:
Must honor prior authorizations (PAs) when item has not been delivered and must review ongoing PAs for medical necessity
Waiver Consumers:
Must honor specified care provider
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Must honor specified care provider
NF Consumers
AL Consumers:
Must honor specified care provider
No LTC Need Consumers:
Must honor specified care provider
Waiver Consumers:
Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified care provider
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified care provider
NF Consumers
AL Consumers:
Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified care provider
No LTC Need Consumers:
Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified care provider
Waiver Consumers:
Must honor specified care provider
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Must honor specified care provider
NF Consumers
AL Consumers:
Must honor specified care provider
No LTC Need Consumers:
Must honor specified care provider
Waiver Consumers:
Must honor PAs when item has not been delivered
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Must honor PAs when item has not been delivered
NF Consumers
AL Consumers:
Must honor PAs when item has not been delivered
No LTC Need Consumers:
Must honor PAs when item has not been delivered
Waiver Consumers:
Keep service, care provider and Medicaid reimbursement rate at current levels. No changes unless:
- A significant change occurs as defined in OAC 5101:3-45-01.
- Member wants to self- direct services.
- 365 days have passed.
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Keep existing service for 90 days. Then review for medical necessity after an in-person assessment with care provider observation.
NF Consumers
AL Consumers:
For AL: Keep existing service for 90 days. Then review for medical necessity after an in-person assessment with care provider observation.
No LTC Need Consumers:
N/A
Waiver Consumers:
N/A
Non-Waiver Consumers with LTC Needs (HH and PDN use):
N/A
NF Consumers
AL Consumers:
Care provider maintained at current rate for the life of demonstration.
No LTC Need Consumers:
N/A
- Personal care
- Waiver nursing
- Home care attendant
- Choice home care attendant
- Out-of-home respite
- Enhanced community living
- Adult day health services
- Social work counseling
Waiver Consumers:
Keep service, care provider and Medicaid reimbursement rate at current levels. No changes unless:
- A significant change occurs as defined in OAC 5101:3-45-01.
- Member wants to self- direct services.
- 365 days have passed.
Non-Waiver Consumers with LTC Needs (HH and PDN use):
N/A
NF Consumers
AL Consumers:
N/A
No LTC Need Consumers:
N/A
Waiver Consumers:
Keep current service level for 365 days and existing service provider for 90 days. Plan-initated change in service provider only occurs after an in- home assessment and a transition plan
Non-Waiver Consumers with LTC Needs (HH and PDN use):
N/A
NF Consumers
AL Consumers:
N/A
No LTC Need Consumers:
N/A
Waiver Consumers:
Maintain service provider, level and rate documented in the BH plan of care at enrollment for 365 days.
Non-Waiver Consumers with LTC Needs (HH and PDN use):
Maintain service provider, level and rate documented in the BH plan of care at enrollment for 365 days.
NF Consumers
AL Consumers:
Maintain service provider, level and rate documented in the BH plan of care at enrollment for 365 days.
No LTC Need Consumers:
Maintain service provider, level and rate documented in the BH plan of care at enrollment for 365 days.