Notice sent to all MLTC members by State DOH in week of Jan. 17, 2020 explaining the change in how nursing home care relates to MLTC. If in a nursing home for more than 3 months, will no longer be eligible for or remain in an MLTC plan. See http://www.wnylc.com/health/entry/199/.

This PDF has 2 form notices being sent in Jan. 2020 to adult Nursing Home Residents approved for Institutional Medicaid, advising them that they won't be enrolled in MLTC plans as previously notified. This is implementing the change approved by CMS for MLTC. See http://www.wnylc.com/health/entry/199/. The 1st notice is to those who received notice that they must select an MLTC plan by a certain date. The 2nd notice in the PDF is to those who were told they'd be assigned to an MLTC plan on February 1, 2020. That enrollment is now canceled.

LDSS-3559 Form RESIDENTIAL HEALTH CARE FACILITY REPORT OF MEDICAID RECIPIENT ADMISSION/DISCHARGE/READMISSION/CHANGE IN STATUS. This is last version of form from 2013, which DOH has said is under revision

This is a list of court decisions, key laws, regulations and directives concerning the various Medicaid home care programs in New York State. Revised Dec. 2018

Update eff 11/12/2018 on implants and replacement of dentures. Policy change results from lawsuit filed in August 2018,
Ciaramella v. Zucker (18-cv-06945), by The Legal Aid Society and Willkie Farr & Gallagher. See http://www.wnylc.com/health/entry/210/

Form designed by NYLAG EFLRP for a managed care or MLTC member to designate a family member, attorney or care manager, provider, and/or the ICAN Ombudsprogram to request a plan appeal, fair hearing, or a change in services from a managed care or MLTC plan. This new form is necessary because of changes starting in March 2018. At that time, one must first request an internal plan appeal before requesting a fair hearing. The request must be signed by the plan member unless a representative was previously designated. Signing this form in advance could prevent harmful delays in obtaining a client signature when requesting an appeal- especially if Aid Continuing is needed. See more at http://www.wnylc.com/health/news/80/

Changes in federal Medicaid regulations will take effect in New York State May 1, 2018. These changes affect over 4.7 million New Yorkers -- all members of Medicaid Managed Long Term Care (MLTC) Plans and “mainstream” Medicaid managed care plans. If the managed care or MLTC plan denies or reduces a service after May 1, 2018, the member will be required to request an internal “Plan Appeal” first, and wait for the plan’s decision, before they request a Fair Hearing with the NYS Office of Temporary & Disability Assistance. In other words, they are required to “exhaust” the internal plan appeal before requesting a fair hearing. See more info about the new rule here -- http://www.wnylc.com/health/entry/184/.

The CLE will explain the new rule and its limited exceptions, and the new appeal process. It will also cover the new requirements for the plan member to “authorize” a representative to request a plan appeal or a fair hearing.

WHO: The CLE is sponsored for lawyer, paralegals, and other professionals working or volunteering in the non-profit sector, including social workers who assist seniors and people with disabilities in accessing Medicaid services.

CLE: The New York Legal Assistance Group has been certified as an Accredited Provider of Continuing Legal Education. 1.5 Professional Practice credits and .5 Skills credits have been authorized for this session. This course is appropriate for both newly admitted and experienced attorneys. CLE credit will not be available for future viewing of the recorded webinar.

COST: Free for those working in or doing pro bono work for a non-profit legal services, advocacy, or social services organization. Private lawyers and geriatric care managers are asked for a suggested donation of $75 per session