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HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms with various forms updated as of 3-24-2023
MAP-259d-e-f-g-t Discharge Alert and Related Nursing Home Forms as of 2023-03-24 (259f -259t+ 648p).pdf
NYC MICSA Medicaid Alerts from 2015 and 2020 with nursing home forms updated as of 3/23/23 including "Discharge Alert" 259d that nursing home physician must sign to certify that resident has a reasonable expectation to return home, which entitles resident to community budgeting (non-chronic care) - so they keep entire community Medicaid allowance rather than only $50/month. Form replaces 1159. PDF includes - Form 259f Notice of Discharge revised 2020 (now includes check-off that resident advised of Special Income Standard for those discharged from NH to MLTC) ; Form 259e (Change/Cancellation of Discharge Plan), 259g (Respite Alert), 259t (updated 5/2020) -- PDF has updated forms as of 3/24/2023 from NYC MARC website.
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25 Mar, 2023
3.04 mb
Downloads: 76485
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MAP-648 P SUBMISSION OF REQUEST FROM RESIDENTIAL HEALTH CARE FACILITIES (RHCF)(05/05/2022)
MAP-648p Submission of request from RHCF-NH 2022-05-05.pdf
Transmittal form for Nursing Home to submit to HRA: new Medicaid application, request to convert coverage from community Medicaid, upgrade coverage, or notify HRA that transfer penalty period expired. (updated 5/5/2022)
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25 Mar, 2023
69 kb
Downloads: 11293
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Medicaid Household Size Chart for Aged, Blind and Disabled Individuals ("SSI-Related")
HOUSEHOLD SIZE FOR SSI RELATED CHART 2023 (using 2022 FPL).pdf
Updated 2023 using the 2022 FPLs. We hope to update it again when DOH adopts the 2023 FPLS.
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22 Jan, 2023
140 kb
Downloads: 52235
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Disabled Adult Child Medicaid Extensions/Continuations
DAC -Pickle- 1619B Chart (OCRed).pdf
This chart discusses the Medicaid Extensions/Continuations for certain special cases of SSI recipients once their SSI has been terminated. Specifically, it compares the eligibility criteria, resource/income levels, residential program requirements, spendown/NAMI contributions, reinstatement, and Medicare Buy-IN eligibility for the following groups:
A. 1619B
B. Pickle
C. DAC
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22 Mar, 2022
103 kb
Downloads: 9206
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2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers
2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers.pdf
2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers - provides instructions for Online Credit Card payment to the Division of Accounts Receivable and Billing (DARB) to participate in the Medicaid Pay-In Program. Link to NYC CityPay website (https://a836-citypay.nyc.gov/) is provided. Medical bills cannot be submitted through this website.
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16 Nov, 2021
124 kb
Downloads: 3926
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2021-08-30 Updated Fax & E-maikl Submissions to HRA Medicaid and HCSP
2021-08-30 Fax-e-Mail submissions to MAP - Home Care Services Preogram.pdf
updates earlier fax lists - allowing submission of applications and other documents by fax during COVID-19 emergency, and adds some email addresses for inquiries
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04 Sep, 2021
152 kb
Downloads: 7158
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Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (07-2020)
Physician's Order Nassau County Form 517 - (2020).pdf
Form for doctor to complete to request Medicaid personal care services and CDPAP from the Nassau County DSS. Revised July 2020.
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26 Aug, 2021
1.46 mb
Downloads: 11499
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CASA Directory Updated 9-09-2020 (Home Care Services Program (HCSP)
2020-09 NYC Home Care Services Program -CASA directory.pdf
CASA field offices have been consolidated. There is one CASA office per borough. Includes announcement of new email address for HCSP inquiries
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04 Aug, 2021
309 kb
Downloads: 7192
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Contact List of CASA Offices - Home Care Services Program (HCSP)
2020-09 NYC Home Care Services Program -CASA directory.pdf
Includes announcement of new e-mail address for inquiries about HCSP cases (7-2021)
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04 Aug, 2021
309 kb
Downloads: 36826
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2020-06-22 NYS Medicaid Program Modifications COVID-19 Emergency
2020-06-22 NYS Medicaid program Modifications COVID-19 Emergency.pdf
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23 Jun, 2020
253 kb
Downloads: 2602
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