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Fact Sheet on Keeping Income During and After a Temporary Nursing Home Stay Download
Fact Sheet on Keeping Income In & After Nursing Home Stays 3-21-2024 FINAL.pdf
NYLAG Fact Sheet on consumer Right to keep more income during a temporary nursing home stay, as well as after a nursing home stay if a consumer is enrolled in a Managed Long Term Care plan or for some consumers who are married.
21 Mar, 2024 816 kb Downloads: 7182
Fact Sheet & Form for Keeping SSI for 90 Days in Temporary Hospital or Nursing Home Placement Download
SSI Temporary Institutional Stay Fact Sheet and Form 2024-03 (3-11-14 VB).pdf
This fact sheet explains requirements for maintaining SSI (Supplemental Security Income) for up to 90 days during a temporary hospital or nursing home stay. The PDF also includes a new official form (2023) for requesting continuation of SSI benefits, which must be filed with the Social Security Administration within strict timelines. Note that if SSI benefits are terminated, Medicaid will also be terminated, after "Stenson" notices are mailed giving the recipient an opportunity to recertify for Medicaid without SSI. See http://www.wnylc.com/health/entry/85/
11 Mar, 2024 312 kb Downloads: 13040
Dental Implant prior auth form Download
318-7 Ciaramella exA6 dental implant form.pdf
20 Dec, 2023 515 kb Downloads: 239
Replacement Denture prior auth form Download
318-6 Ciaramella exA5 replacement denture form.pdf
20 Dec, 2023 522 kb Downloads: 185
HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms with various forms updated as of 3-24-2023 Download
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.
25 Mar, 2023 3.04 mb Downloads: 74133
MAP-648 P SUBMISSION OF REQUEST FROM RESIDENTIAL HEALTH CARE FACILITIES (RHCF)(05/05/2022) Download
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)
25 Mar, 2023 69 kb Downloads: 10316
Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (07-2020) Download
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.
26 Aug, 2021 1.46 mb Downloads: 10687
NYLAG, MFJ & NYAIL Letter to DOH 4-13-20 re Economic Stimulus Payments for Nursing Home & Adult Home residents Download
Advocacy Ltr to DOH re economic impact payments for NH and Adult Home residents.pdf
Letter dated April 13, 2020 requesting that DOH issue guidance to Nursing Home, Adult Home & ALP administrators that the Economic Stimulus payments are exempt from being counted for Medicaid, and must be protected for the residents.
14 Apr, 2020 296 kb Downloads: 2213
NYSDOH Dear Administrator Letter to Nursing Homes 1-21-2020 re Disenrollment from MLTC of Nursing Home Residents Download
NHBL DAL Final 2020-01-21.pdf
NYSDOH Dear Administrator Letter to Nursing Homes 1-21-2020 advising them that residents who are members of MLTC plans will be disenrolled after 3 months. The letter should eventually be posted with other DAL letters here - https://www.health.ny.gov/professionals/nursing_home_administrator/letters.htm#dal. See discussion in this article http://www.wnylc.com/health/entry/199/
22 Jan, 2020 193 kb Downloads: 2544
Disenrollment Notice Sent to MLTC Members who are Long Term Nursing Home Residents Download
DU_MLTC_NH_E_1019 Disenrollment notice - NH.pdf
New Disenrollment Notice form to be sent by NY Medicaid Choice to MLTC Members who have been identified as "Long Term Nursing Home Residents" (In nursing home more than 3 months). Notice has Fair Hearing rights. See more here http://www.wnylc.com/health/entry/199/
22 Jan, 2020 600 kb Downloads: 2487
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