There a many different types of home care providers in New York. However, there are three types of mainstream providers which administer most home care services. They are: Managed Long-Term Care (MLTC) Plans, Certified Home Health Agencies (CHHAs), and Licensed Home Care Services Agencies (LHCSAs). The following are outlines of each provider type:
People who are dual-eligible (meaning they have both Medicare and Medicaid), age 21 and older, and are in need of home care for more than 120 days are required to enroll in a Managed Long-Term Care (MLTC) plan. These plans are responsible for providing home care and other long-term care services (such as adult day care). Plans receive a monthly premium from Medicaid for each member. The amount of this premium is fixed and does not change based on the needs of the member.
Managed Long-Term Care plans operate as an insurance model. As such, most of the services that they cover are provided by vendors or contracted providers. Home care is an example of this. Plans do not employ home attendants directly. Rather, they contract with Licensed Home Care Services Agencies (LHCSAs) to provide these services.
There are four different types of Managed Long-Term Care plans: Partial MLTC, PACE (Programs of All-Inclusive Care for the Elderly), MAP (Medicaid Advantage Plus), and FIDA (Fully Integrated Dual Advantage). Each plan type has it’s own unique properties. For a description of each plan type and to learn more about MLTC plans, see Managed Long-Term Care (MLTC) Plans.
Certified Home Health Agencies (CHHAs) provide skilled services such as nursing, physical therapy, and occupational therapy to home-bound patients. They also provide social workers and contract with Licensed Home Care Services Agencies (LHCSAs) to provide home health aides for their patients. CHHA services tend to be short-term. They are often provided upon a patient being discharged home from a hospital or rehabilitation facility.
CHHAs operate as healthcare providers and they may receive payment from Medicare (including Medicare Advantage plans with whom they are in-network), Medicaid, private pay, and other insurers. As a Medicaid “provider”, CHHAs are in the unique position of being able to authorize Medicaid pending home care services. This happens when a CHHA authorizes Medicaid level services while a Medicaid application is still only pending and has not yet been approved. Once the application is approved, the CHHA can bill Medicaid for the services it laid out while the application was pending. To learn more about Medicaid pending, see Medicaid Pending.
Licensed Home Care Services Agencies (LHCSAs) employ home attendants. They may also employ nurses and licensed practical nurses. If someone is authorized to receive a home attendant by a Managed Long-Term Care plan or a Certified Home Health Agency, a sub-contracted LHCSA will send the attendant. LHCSAs can also be contracted privately for home attendant services. For those with long-term care insurance, a LHCSA can often bill the insurance company directly if the insured signs an “Assignment of Benefits” or “Direction to Pay”.
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