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GIS 23 MA-14 Attachment III
GIS 23 MA-14 - Attachment III.pdf
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04 Jul, 2023
180 kb
Downloads: 285
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GIS 23 MA-14 Attachment II
GIS 23 MA-14 - Attachment II.pdf
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04 Jul, 2023
150 kb
Downloads: 233
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GIS 23 MA-14 Attachment I
GIS 23 MA-14 - Attachment I.pdf
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04 Jul, 2023
819 kb
Downloads: 222
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GIS 23 MA-14 Updates to Medicaid Renewals and Other Processes in the Unwind Period
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04 Jul, 2023
210 kb
Downloads: 318
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NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2022
2001_to_2022_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2022. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
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21 Jan, 2023
3.78 mb
Downloads: 299064
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NYS Dept. of Health Memo Jan. 13, 2023 with Timeline of Unwinding of Public Health Emergency
2023-01-13 DOH Unwind Timeline guidance.pdf
NYS Dept. of Health Memo Jan. 13, 2023 with Timeline of Unwinding of Public Health Emergency - when renewals and discontinuances will start, and when the "easements" that loosen documentation requirements for applications will cease and full documentation will be required
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20 Jan, 2023
357 kb
Downloads: 1041
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Form DOH-5143 - Medical Disability Form - replaces LDSS-486T (08-2018)
DOH-5143 Replaces 486T Medical Report for Determination of Disability (08-2018) - FILLABLE.pdf
Form to be signed by treating physician to certify disability as required for approval of Supplemental Needs Trusts, or for Medicaid based on disability where the Social Security Administration has not determined disability. Replaces Form 486T. See HRA MICSA Alert Dec. 20, 2021, available at http://www.wnylc.com/health/fdownload/799/
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22 Dec, 2021
50 kb
Downloads: 3841
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DOH Model 30-Day Notice of Intent to Disenroll from MLTC Plan for Long Term Nursing Home Stay
Plan Intent to disenroll Batch Process_07.01.21_Final.pdf
Notice sent by MLTC plans to members of intent to disenroll because of a Long Term Nursing Home Stay - a stay of more than 3 months, where the member has been approved for Nursing Home Medicaid. Notice sent 30 days prior to disenrolllment. A second notice is sent by NY Medicaid Choice 10 days prior to disenrollment, posted with more info in this article http://www.wnylc.com/health/entry/199/
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20 Oct, 2021
83 kb
Downloads: 1250
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"Coverage Determination Notice" - Official Template for NYS MAP Plans using Integrated Appeal process
ICDN_NY_MAP - Coverage Determination Notice 11.15.19.docx
Official template for NYS Medicaid Advantage Plus plans to deny an initial request for prior approval for a service or for an increase in a service. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.
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01 Apr, 2021
64 kb
Downloads: 1419
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"Appeal Decision Notice" for NYS Medicaid Advantage Plus plans (MAP)
AppealDenial_NY_MAP FINAL 11.15.19.docx
State template for final decisions after the internal plan appeal in the new integrated appeal procedure that began in 2020 for MAP plans. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.
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01 Apr, 2021
81 kb
Downloads: 1446
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