Skip left navigation

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.