Fact Sheet on New Rules for Appealing Actions by Medicaid Managed Care and MLTC Plans - Starting May 1, 2018 - by NYLAG Evelyn Frank Legal Resources Program

Compilation of regulations, sample notices, forms, advocacy documents, fact sheets, and online references for CLE Webinar conducted by NYLAG EFLRP on April 18, 2018 on the new Appeals REquirements for Medicaid Managed Care as Implemented in NYS Effective May 1, 2018 (amended slides 5 and 7 4/22/18)

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

NYLAG Testimony on NYS FY 2018-19 Budget - Joint Hearing of the Senate Finance and Assembly Ways and Means Committees - discusses spousal refusal and spousal impoverishment proposals, Managed long term care changes, and other proposals in NYS proposed budget.

This is an unofficial sample of the model notice template that NYS DOH has given to Managed care and MLTC plans, to use after March 1, 2018. This is the notice for reducing services such as personal care. This sample was created by NYLAG on hypothetical facts. It is not an official sample. The official template is posted at http://www.wnylc.com/health/download/643/.

Fact Sheet about a 1994 federal law that exempts restitution to victims of Nazi persecution from being counted toward eligibility for federally funded benefits. Fact sheet originally produced by the Evelyn Frank Legal Resources Program when it was housed at Selfhelp Community Services, in conjunction with the Claims Conference. Updated by the Evelyn Frank program that moved to the New York Legal Assistance Group in 2013. (updated Nov. 2017 to include Polish restitution payments)

This PowerPoint presentation explains the rules, also see the Training Outline on Medicaid Spend-down posted on this site (revised 2017).

Chart shows impact of withdrawal of Guildnet from Nassau, Suffolk and Westchester Counties per letters sent to 4000+ members in March 2017. See http://www.wnylc.com/health/download/621/

Part D Benchmark Plans 2017 - NYS - Comparison to 2016 Plans