Providers of Long Term Services and Supports (LTSS) Must Verify Medicaid Eligibility

Date Issued: 5/2/2014

Reminder: LTSS Provider Responsibilities

Providers of Long Term Services and Supports (LTSS) are required by the New York State Department of Health (NYSDOH) to verify the Medicaid eligibility and managed care enrollment status of their patients twice monthly.

LTSS services include: private duty nursing, home health care, personal care, Consumer Directed Personal Assistant Services (CDPAS), Adult Day Health Care (ADHC), AIDS ADHC and nursing home stays.

LTSS providers are required to:

  • Check eMedNY or ePACES on the 1st and 15th of every month to:
    • Verify Medicaid eligibility.
    • Determine if the member has coverage through Medicaid FFS or a Managed Care Plan (MCP).
    • If the member has changed MCPs and if so, the name of the new MCP.

  • If the member has enrolled in an MCP or changed MCPs:
    • Notify the MCP as soon as possible that you are providing LTSS to their new member.
    • Share the most recent Physician’s Order, member assessment and care plan.
    • Obtain the MCP’s authorization to provide services according to the Member’s existing care plan for a 90-day transition.

Checking Medicaid eligibility and MCP enrollment, and notifying the MCPs will result in the early identification and seamless transition of new members in receipt of LTSS.