About Coordinated Long-Term Services

Q1: What is Coordinated Long-Term Services (CLTS)?

A: CLTS is a Medicaid managed care program that will provide and coordinate services to certain Medicaid recipients. This will include all physical health and/or long-term care services, such as: doctor visits, hospital services, home and community-based services and long-term services. Individuals enrolled in CLTS will receive their services under a           managed care setting.

There are two CLTS Managed Care Organizations (MCOs) that people will be able to choose from to receive services. Persons who will get services under this managed care setting include: Disabled & Elderly (D&E) Waiver recipients, Personal Care Option (PCO) consumers, nursing home residents and people who have Medicare and Medicaid and are not getting long-term services, and people approved for the Mi Via Waiver who were approved through the Disabled and Elderly Waiver or brain injury category of eligibility. People in Mi Via who are enrolled in CLTS will get their Mi Via services as they do now, but get their physical health services under CLTS.

Q2: Who are the CLTS MCOs?

A: AMERIGROUP and Evercare.

Q3: How will individuals benefit from CLTS?

A: The CLTS MCO will help people get the health care and long-term services they need in the place that can best meet their needs. The goal of CLTS is to help people get the services they need and still be able to stay in their home and in their town.

Eligible Populations

Q4: Which Medicaid populations are included?

A: Disabled and Elderly (D&E) Waiver recipients, Personal Care Option (PCO) consumers, nursing facility residents, and recipients who have both Medicaid and Medicare benefits. Clients approved for the Mi Via Waiver who have been approved under a Disabled and Elderly Waiver or brain injury category of eligibility will receive only their physical health services under CLTS, and they will continue to self-direct their home- and community- based waiver services under Mi Via. Note: Individuals currently enrolled in the Developmental Disabilities (DD), Medically Fragile (MF), and AIDS Waivers will NOT be in CLTS.

Q5: If I have Medicaid and Medicare, will CLTS change my Medicare services?

A: No. Your Medicare services will not change. Your CLTS MCO service coordinator will help to coordinate your Medicare and Medicaid services.

Q6: I currently am receiving services through the PACE (Program of All-Inclusive Care for the Elderly) program. Will my services be included in CLTS?

A: The PACE program is not part of CLTS. Your services will not be affected and you will continue to receive your services from PACE.

CLTS Eligibility

Q7: How is eligibility for CLTS decided?

A: You are eligible for CLTS if you have Medicare and Medicaid and you aren't getting long-term services; if you have Medicaid and are a resident of a nursing home; if you are getting services from the D&E Waiver; if you are getting PCO services or if you qualified for the Mi Via program through the D&E Waiver or brain injury category of eligibility.

Q8: Do I need to go through an application process now?

A: If you are currently getting Medicaid services under the D&E Waiver or PCO program, are a resident of a nursing home receiving Medicaid, have both Medicaid and Medicare benefits, or are in the Mi Via program with a Disabled and Elderly Waiver or brain injury category of eligibility, you will be enrolled into CLTS without having to go through an           application process. If you are not currently receiving these types of services, you will need to apply for Medicaid services through your local Income Support Division office. If you have questions about the CLTS program, please call the Resource Center at 1-800-432-2080.

Q9: Will CLTS change my place on the D&E Central Registry?

A: If your name is on the registry and you are waiting to receive services through the D&E Waiver, your place on the registry will not change.

Getting Started with CLTS

Q10: How can I find out about CLTS and get started?

A: During the first half of May, 2008, an introduction letter was mailed to eligible individuals receiving nursing facility services in or living in the Bernalillo, Sandoval, Torrance, Santa Fe, Valencia and Los Alamos Counties with information about CLTS. The letter asked you to pick a CLTS MCO to receive your services. CLTS target start date for implementation in these counties is July 1, 2008. If you receive services or live in another county, you will receive an introduction letter when CLTS starts in your area. 

Q11: How much time do I have to pick a CLTS MCO?

A: You will have at least 16 days to pick your MCO. If you do not pick one, you will be assigned to a CLTS MCO.

Q12: I have a Salud! member card from Presbyterian that my doctor and pharmacy ask to see and Presbyterian has approved services for me. When I get a member card from the CLTS MCO I choose, can I still get my approved services?

 A: Your enrollment in Salud! will end when you enroll in CLTS. The CLTS MCO will send you a new member Identification (ID) card. The Salud! MCO will then tell the CLTS MCO about any services approvals in effect at that time, which the CLTS MCO will follow for up to 60 days for services and up to 90 days for medications. Your CLTS MCO will review your service needs within 60 days of your switch to CLTS and put together a service plan that fits your needs.

Q13: Can I change my CLTS MCO?

A: Yes, you can change your CLTS MCO within 90 days of choosing or being assigned to a CLTS MCO. You will receive a CLTS Enrollment Notice telling you how you can change to a different CLTS MCO.

Services and Benefits

Q14: What services are included in CLTS?

A: The same Medicaid services that are available now will be included in CLTS. These services include doctor visits, hospital, emergency and other health services, and home- and community-based and long-term services.

Q15: If I am receiving behavioral health services will I now have to get them in CLTS?

A: No. You will continue to get your behavioral health services from the statewide entity, currently Value Options New Mexico.

Q16: Exactly what are long-term services?

A: Long-term services help to meet the medical and non-medical needs of people with a chronic illness or disability who need support over a long period of time. Examples of long-term services are: adult day care, personal care and supports, respite and assisted living services. Long-term services can be provided in an assisted living center or nursing home, and in your home and the community.

Q17: Will the CLTS MCO have a list of providers in the state that are available to provide services?

A: The CLTS MCO will have a list of its providers (called "in network" providers). These are providers that have signed contracts with the CLTS MCO, are in the CLTS MCO's provider network, and are available to provide services.

Q18:  Can I keep my current service providers when I move to CLTS?

A: Your Medicaid providers (such as your doctor, therapist, nursing home, home health agency, or personal care option agency) must contract with your CLTS MCO in order for you to continue to receive services from your current providers. Ask your providers if they are one of your CLTS MCO's providers. You can also ask the CLTS MCO whether your providers are on the provider network list. If your providers are not one of your MCO providers, they can contact the CLTS MCO for information to become one of their providers. If your Medicaid provider does not want to work with your CLTS MCO, your CLTS MCO will assist you to find a provider.

Q19: Can I be guaranteed that my current services are not going to be stopped while I am moving to CLTS?

A: The State is working to make sure that the services you currently receive continue when you move into CLTS.

Q20: If I am receiving services through the D&E Waiver, will I still get my D&E Waiver services in CLTS?

A: Your D&E Waiver case manager will assist you with your move to your new CLTS MCO. Once you have picked or are assigned to a CLTS MCO, you will receive your D&E Waiver services through your new CLTS MCO. Your CLTS MCO will assign you a service coordinator, who will assist you in answering your questions and getting your services.

Q21: Will my homemaker/personal care hours remain the same?

A: Your homemaker/personal care hours will remain the same when you first move to CLTS. However, the CLTS MCO you choose will be responsible for meeting with you to make sure that the services you are currently receiving meet your needs. You may need new or different services.

Q22: Are there any age limits for CLTS services?

 A: Yes, some CLTS services have age limits. This is not any different from the age limits that exist today under Medicaid. Your CLTS MCO will explain if there is an age limit for a service you want or need.

Q23: Are CLTS services only available in New Mexico? What happens if I am out of state and need services?

A: Your CLTS MCO must approve services for you in another state. This means the CLTS MCO must tell you it is okay for you to receive services in another state. Your CLTS MCO service coordinator will be able to tell you about services in another state and get those services approved. Emergency medical services are available anywhere in the United States and do not require prior authorization.

Q24: Can Native Americans use Indian Health Service (IHS) or Tribal clinics even if they are enrolled in CLTS?

A: Yes, when they are in CLTS, Native Americans may still use IHS and Tribal clinics, hospitals, pharmacies, and doctors to receive services.

Q25: I am a Native American and my Medicaid enrollment is "exempt" status. Will I still be "exempt" in CLTS?

A: Your enrollment as "exempt" for managed care will end when you enroll in CLTS. You will be able to choose which CLTS MCO you want to enroll with and they will send you a new member ID card. You will show your CLTS MCO card to service providers when you ask for or receive services. As a Native American, you will continue to be able to get services at IHS and Tribal clinics and hospitals.

Contact State

Q26: Will there still be someone at the State to call if I need to?

A: Yes, you can call the Aging and Long-Term Services Department's Resource Center at 1-800-432-2080.