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.

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.

Sample Notice sent to MLTC Members in October 2020 Explaining new Lock-In Rule that Starts Dec. 1, 2020. This notice is from VNS Choice, but each plan would be sending their own versiono n their letterhead, using State-approved language.

Language that Plans must add to their MLTC Member Handbooks to explain the new Lock-in that begins Dec 1, 2020 for people enrolling in a plan after that date, whether a first-time enrollee or changing plans on or after that date

NYSDOH Dear Administrator Letter (DAL) to Nursing Homes 6/11/2020 revising the one issued 1-21-2020 (posted at http://www.wnylc.com/health/download/718). DAL advising them that residents who are members of MLTC plans will be disenrolled after 3 months in NY. 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/

NYS EPIC Application (DOH-5080)(May 2015) Fill-able version. This version was supposed to be phased out in 2020, replaced by a new version posted on EPIC website https://www.health.ny.gov/forms/doh-5080.pdf. However, DOH indicated it will accept the 2015 version. An April 29th letter signed by Donna Frescatore, of the NYS Dept of Health Office of Health Insurance Programs: "We understand your concerns regarding COVID-19 and ensuring that seniors get access to needed medications. As such, we will continue to accept the prior version of the
EPIC application until after the emergency period and will also work closely with seniors to obtain the information needed so the EPIC program staff can facilitate their applications for the Extra Help program."

Guidance to local Departments of Social Services regarding streamlining Medicaid applications and enrollment, and suspending discontinuance actions during the pandemic emergency

Revised form Notice to be sent by New York Medicaid Choice to about 23,000 MLTC members who, as of April 2020 have been in nursing homes for 3+ months, telling them they will be disenrolled from the MLTC plan unless they request an assessment to return home or a fair hearing before the effective date, May 1, 2020.

Excerpt of State publication that explains the millions of eligibility codes that show restrictions on or categories of individual's Medicaid eligibility. The entire guide is much bigger. This SEARCHABLE excerpt contains the chapter on MEDICAID CODES.

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/