MLTSS Benefits

MLTSS refers to the delivery of long-term services and supports through New Jersey Medicaid's NJ FamilyCare managed care program. MLTSS is designed to expand home and community-based services, promote community inclusion and ensure quality and efficiency.

Horizon NJ Health coordinates all services for MLTSS members. The program provides comprehensive services and supports, whether at home, in an assisted living setting, in community residential services, or in a nursing home.

In addition to NJ FamilyCare A benefits, the following services may be available to MLTSS members:

• Adult Day Health
• Adult Family Care
• Assisted Living Program
• Assisted Living Services
• Caregiver/Participant Training
• Chore Services
• Community Residential Services
• Community Transition Services
• Home-Based Supportive Care
• Home-Delivered Meals
• Medication Dispensing Device
• Non-Medical Transportation
• Nursing Facility Services (Custodial)
• Pediatric Day Health
• Personal Care Assistant
• Personal Emergency Response Systems
• Private Duty Nursing (Adult)
• Residential Modifications
• Respite (Daily and Hourly)
• Social Adult Day Care
• Specialized Medical Equipment and Supplies
• Traumatic Brain Injury (TBI) Behavioral Management (Group and Individual)
• TBI Cognitive Therapy (Group and Individual)
• TBI Occupational Therapy (Group and Individual)
• TBI Physical Therapy (Group and Individual)
• TBI Speech, Language and Hearing Therapy (Group and Individual)
• 创伤性脑损伤,Structured Day Program
• 创伤性脑损伤,Supported Day Services
• Vehicle Modifications

Medicaid beneficiaries who were residing in nursing facilities prior toJuly 1, 2014, have remained in the

医疗服务收费项目。所有护理facility residents eligible for Medicaid afterJuly 1, 2014, are required to enroll with a managed care plan and must be covered through managed care.

Horizon NJ Health's Website

Our websiteis a source of information about plan features, important news, tools and resources, as well as corporate policy. Our goal is to provide relevant information for members, physicians, providers and the general public.

Medical PoliciesandClinical and PreventiveGuidelines are available on the site. Medical policies are posted a minimum of 30 days prior to their effective date.

Additional materials are posted as a resource for all providers, including the formulary, forms and guides.

If you have any questions, please contact MLTSS Provider Services at1-855-777-0123.

Provider Directory

Horizon NJ Health publishes a searchableProvider Directory. All participating providers are listed, including doctors, hospitals, laboratory services, pharmacies, dental and non-medical professional providers. The information is updated daily.

Printed copies of the Provider Directory are available by calling MLTSS Provider Services at1-855-777-0123.

As a condition of participation in our network, providers are required to update their demographic and practice roster information when it changes.

A copy of the guide for changing provider information can be found on ourDemographics updatespage. Documentation can be emailed toEnterprisePDM@HorizonBlue.comor mailed to:

Horizon BCBSNJ
3 Penn Plaza East
Mail Station PP 14 C
Newark, NJ 07105

Please send documentation to us regarding changes in your practice, such as:

• Office relocation address
• Changing the name of your practice
• Changing your phone number
• Changing your fax number
• Changing your tax ID number
• Adding or removing a physician to or from your practice
• Changing your hospital affiliation
• Receiving new or updated documents related to your credentialing or recredentialing process
• Changing the open or closed status of your panel (this applies to PCPs only and has a 90 day waiting period)
• Changing your address, including your billing address

Failure to update this information can result in denial of payment and potential removal from the network. Newly enrolled members are sent a Provider Directory that is limited to include only the Primary Care Providers (PCP), dentists, Ob/Gyns, vision providers, hospitals, health centers and pharmacy locations specific to their county. These county directories are updated monthly.

If your office information is not correctly shown in these publications, please complete a Request for Change of Information form, fax it to Professional Contracting & Strategy at1-973-274-4126or email it toproviderfileops2@HorizonBlue.com. A copy of the form can be printed from the Horizon NJ Health website athorizonNJhealth.com.

Health Literacy

Health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” Low health literacy affects people of every age, ethnicity, background and education level.

Impacts on Patient Care

People with low health literacy are less likely to adhere to prescribed treatment and self-care regimens. They are also less likely to seek preventive care and are at a higher risk for hospitalization. People with low health literacy often require additional care that results in annual health care costs four times higher than for those with a higher literacy level.

Horizon NJ Health has adopted improvements in health literacy as a means of eliminating barriers to care and improving member health outcomes.

What you, the provider, can do:

• Create a safe environment where patients feel comfortable talking openly with you.
• Use plain language instead of technical language or medical jargon.
• Sit down (instead of standing) to achieve eye level with your patient.
• Use visual models to illustrate a procedure or condition.
• Ask patients to perform a return demonstration of the care instructions you give to them.

Cultural Competency

Providers shall demonstrate cultural competency in the following ways:

• Assess members and document in the medical record the presence of cultural and/or language barriers to care.
• Seek information from members, families and/or community resources to assist in servicing and responding to the needs and preferences of culturally and ethnically diverse members and families.
• Display pictures, posters and other materials that reflect the cultures and ethnic backgrounds of members and families.
• Provide magazines, brochures and other printed materials that reflect diverse cultures in waiting areas.
• Understand that folk and religious beliefs may influence how families respond to illness, disease, death and their reaction and approach to a child born differently-abled.
• Understand that the family unit can be defined differently by different cultures.
• Whenever possible, seek to employ bilingual staff or trained personnel to serve as interpreters.
• Understand that a member and/or family's limitation in English proficiency is in no way a reflection of their level of intellectual functioning.