FAQ for MLTC

What is an MLTC?
MLTC, or Managed Long-Term Care, is a Medicaid plan that combines insurance with care coordination through a registered nurse for people who qualify for skilled nursing but can remain in the community if they have access to services that could support them in their home environment.

Who qualifies for the Kalos MLTC?
A person must meet the following criteria to be a member of the Kalos Health MLTC plan.

– 18 years of age or older
– Live in Erie, Niagara, Monroe, Orleans, Genesee or Chautauqua counties
– Eligible or currently covered by Medicaid
– Able to safely live at home with assistance with ADLs (bathing, dressing, grooming, food preparation, mobility, etc.)
– Requires home and community-based services for 120 days or more.
These services include:
* Private duty nursing
* Physical, occupational or speech therapies
* Nursing services in the home
* Home health aide services
* Adult day health care services
* Personal care services in the home
* Consumer Directed Personal Assistance Services (CDPAS)

What are some of the services offered with Kalos Health?
All members have an assigned care team that consists of an RN care manager, a social worker and a member services representative. The member or caregiver will consistently speak with the same people to create a continuity of care.

What are some of the provider types in the Kalos network?
The following are just some of the provider types offered through the Kalos Health MLTC network:
* Home health care (nurses & aides)
* Adult day programs (social day & medical day)
* Physical, occupational and speech therapies (at home & in the community)
* Emergency Personal Response System (PERS)
* Home delivered meals
* Non-emergent Transportation
* Durable medical equipment
* Respiratory Therapy
* Prosthetics & orthotics
* Skilled nursing facilities
* Respite services

How do I make a referral to Kalos Health?
The first step is to call our Enrollment Specialist at 716-304-1212. After determining if you patient is qualified, the Enrollment Specialist will then connect your patient with New York State Medicaid Choice (MAXIMUS), which will coordinate an evaluation to determine eligibility.

Once referred, how long will it take for a person to become enrolled with Kalos Health?
A person can only begin membership on the first day of a month, so their enrollment process must be completed by the 20th day of the previous month.

Will your members have 24/7 assistance available to them?
Yes, all members will be able to use our 24-hour helpline, which is 716-304-1212.

If an active Kalos member is returning home with services (homecare, DME, meals, etc), how does that get set up?
Simply call 716-304-1212 at and we will set up and coordinate any eligible services that are needed. All services will be coordinated through our Care Manager, who builds the plan of care based upon each unique member’s needs.

If an active Kalos member needs to be transported to a sub-acute, skilled nursing or other type of facility, what is the process?
Call 716-304-1212 any time of day and transportation will be coordinated. Please be sure to only use providers within the Kalos Health network. You can find our Provider Directory on our website. The Care Manager will authorize services.

If there is a complaint or issue, how is it handled? 
Call 716-304-1212 and explain the situation to one of our Member Services Representatives. Very often, they will find a solution. If necessary, the issue will be escalated to a manager to resolve or the individual may choose to file a formal grievance with the Plan.

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