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 the following counties: Erie, Niagara, Monroe, Orleans, Genesee or Chautauqua
– Eligible or currently covered by Medicaid
– Live at home with assistance for living activities (bathing, dressing, food preparation, mobility)
– Requires home and community-based services for 120 days or more, including:
* 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 & speech therapies (at home & in the community)
* Emergency Personal Response System (PERS)
* Home delivered meals
* Non-emergent transportation
* Durable medical equipment
* Respiratory therapy
How do I make a referral to Kalos Health?
The first step is to call our Enrollment Specialist at 716-216-8368. After determining if you patient is qualified, the Enrollment Specialist will connect you 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 716-216-8368.
If a member is returning home with services (home care, DME, meals) how does that get set up?
Call 716-216-8368 and we will coordinate eligible services that are needed. Services will be coordinated by a Care Manager based upon each member’s needs.
What is the process sfor a member being transported to a sub-acute, skilled nursing or other facility?
Call 716-216-8368 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 716-216-8368 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.