Managed Long Term Care Plan Members
Managed Long Term Care (MLTC) helps people who are chronically ill or have disabilities and who need health and long-term care services, such as home care or adult day care, stay in their homes and communities as long as possible. The MLTC plan arranges and pays for a large selection of health and social services, and provides choice and flexibility in obtaining needed services from one place.
Managed Long-Term Care Plans (MLTCP) provide long-term care services (like home health and nursing home care) and ancillary and ambulatory services (including dentistry, and medical equipment), and receives payment from Medicaid. Members get services from their primary care physicians and inpatient hospital services using their Medicaid and/or Medicare cards.
Thank you for being a member of Centers Plan for Healthy Living. As a member, we want to provide you with the quality service that you deserve and are specific to your individual needs. We recognize that the more information we provide, the better informed you, and your family and your physicians will be to make the right decisions regarding your healthcare.
It is our pleasure to serve you.
MLTC Language Assistance Services Notification
ATTENTION: Language assistance services, free of charge, are available to you. Call 1-844-274-5227 (TTY: 1-800-421-1220).
MLTC Notice of Nondiscrimination
Centers Plan for Healthy Living, LLC complies Federal civil rights laws. Centers Plan for Healthy Living, LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
MLTC Frequently Asked Questions
MLTC Care Management Services
When you enroll, you, your Doctor, and the CPHL Care Management Team, will work together to develop a plan of care that meets your needs and is medically necessary. Medically necessary services shall mean services that are necessary to prevent, diagnose, correct or cure conditions that cause you acute suffering, endangers your life, results in illness or infirmity, interferes with your capacity for normal activity or threatens some significant handicap. The service plan is a written description of all the services you need. It is based on your Care Team’s assessment of your health care needs, the recommendations of your Doctor, and input from you and your family or caregivers.
MLTC Eligibility Requirements
WHO IS ELIGIBLE FOR CENTERS PLAN FOR HEALTHY LIVING’S MANAGED LONG TERM CARE PLAN (MLTCP)?
Eligibility depends on several criteria, which include but are not limited to the following:
- Must be at least 21 years old.
- Must live in our contracted service area, which includes Bronx, Erie, Kings (Brooklyn), New York (Manhattan), Nassau, Niagara, Queens, Richmond (Staten Island), Rockland, Suffolk and Westchester counties.
- Must need more than 120 days of Community Based Long Term Care Services.
- Must be Medicaid eligible
MLTC Grievances and Appeals
What are Grievances and Appeals?
A grievance is any communication by you to us of dissatisfaction about the care and/or treatment you receive from our staff or providers of covered services. For example, if someone was rude to you or you do not like the quality of care or services you have received from CPHL, you can file a grievance.
An appeal is a type of complaint that expresses your disagreement with a decision made by CPHL regarding your services. You can ask us to review that decision by filing an appeal and we will decide if the action taken was appropriate.
MLTC Service Authorizations
Centers Plan for Healthy Living Utilization Management Service Authorizations is based on the premise that quality medical care is the single-most-important element in delivering health care services. It is a coordinated and comprehensive program designed to monitor access to health care services to members. Utilization Management decisions made by CPHL are based solely on the necessity and appropriateness of care and service.
- CPHL does not compensate those responsible for making UM decisions in a manner that permits them to deny coverage for medically necessary and appropriate covered services.
- CPHL does not offer our employees performing UM reviews incentives to encourage denials of coverage or service, and does not provide financial incentives to providers to withhold covered health care services that are medically necessary and appropriate.
- CPHL emphasizes the provision of medically necessary and cost-effective delivery of health care services to members and encourages the reporting, investigation, and elimination of under utilization.
MLTC Find a Provider
MLTC Referral Form
To view referral form click here.
By phone (toll free): 1-855-270-1600
Seven days a week, 8AM-8PM
TTY/TDD users (toll free): 1-800-421-1220
By email: firstname.lastname@example.org
Centers Plan for Health Living
75 Vanderbilt Ave
Staten Island, NY 10304
If you have an urgent concern,you can contact us 24 hours a day,7 days a week at 1-855-270-1600
MLTC Service Areas
- Managed Long Term Care serves the following 11 counties in New York State:
- Kings (Brooklyn)
- New York (Manhattan)
- Richmond (Staten Island)
- Rockland Counties
MLTC Upcoming Events
For more information about Managed Long-Term Care Plans, please click here .
Do you have a complaint? Call 1-800-MEDICARE or visit medicare.gov