LTSS MAC Membership Application

The information on this application will be used by the LTSS Member Advisory Committee for the selection of committee members based on state requirements to maintain a committee representative of Vaya plan members who utilize long term services and supports and other stakeholders who are connected to long term services and supports. The confidentiality of individuals applying for committee membership will be protected in accordance with federal and state law.

If you have any questions about the LTSS Member Advisory Committee or this application, please contact Vaya’s Member Engagement team at member.engagement@vayahealth.com or call 1-800-893-6246, extension 4401.

General Information

Membership requirements:(Required)
The LTSS Member Advisory Committee shall reflect the LTSS populations (or their representatives) covered by Vaya Health’s Behavioral Health and Intellectual/Developmental Disability (I/DD)Tailored Plan and include up to five committee members in each of the following categories. Please check the areas that describe you.
Please complete this section if you checked (1) LTSS providers (2) Care managers from AMH+ practices and CMAs serving members with LTSS needs or (3)Vaya Health staff involved in the authorization of LTSS and/or care management of LTSS members in the section above.

Demographic Information

Gender(Required)
Please select one option.
County Represented(Required)
Please select one option.
Ethnic Group(Required)
Check all options that apply.

Additional Information

I am willing to have my name placed on the LTSS Member Advisory Committee member list.(Required)
Responsibilities: Membership on the LTSS Member Advisory Committee requires a moderate level commitment of time and energy. Participation involves attending quarterlymeetings and occasional subcommittee meetings. No special knowledge or training is required to serve on the committee, just a desire to improve the system. Additional reading on topics related to long term services and supports issues is required. This material will be provided.
I am committed to partnering with Vaya to ensure high-quality services for all Vaya plan members who utilize long term services and supports.(Required)
I am committed to attending quarterly LTSS Member Advisory Committee meetings lasting two to three hours.(Required)
I am committed to reading materials that are provided.(Required)
If applicable, I understand that my participation in public activities of the LTSS Member Advisory Committee may identify me as a Vaya plan member or a family member of a Vaya plan member who utilizes long term services and supports.(Required)

Need Help?

Finding care can be confusing sometimes. At Vaya Health, we make it easier. The process starts with a phone call to our Member and Recipient Services Line at
1-800-962-9003.