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Medicaid Managed Care
NYLAG Comments to CMS Proposed Standards for Improved Access to Home & Community Based Services Download
NYLAG Comments HCBS-Access Rule 6-30-23 CMS-2442-P.pdf
NYLAG filed these comments on June 30, 2023 to the federal CMS Medicaid agency's proposal to improve standards for accessing Home and Community-Based Services (HCBS) Provisions - see CMS summary at https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking and

18 Sep, 2023 940 kb Downloads: 33
NYC HRA Medicaid Alert NY Independent Assessor & Changes to Personal Care (PCS) Assessment Process (5/31/23) Download
2023-05-31 NYIA and Changes to Personal Care Assessment Process.pdf
Explains what consumers seeking Medicaid CDPAP or personal care (PCS) should do in 2 situations: (1) Those who contacted NYIA directly, rather than applying for Immediate Need services and who are not in a Mainstream Medicaid managed care plan (known as "Fee for service (FFS) consumers") - If the NYIA notice says they are not eligible to enroll in MLTC and refers them to the LDSS - they should fax a copy of their NYIA decision notice to the CASA Central Intake unit (718) 636-7784. Case will be assigned to a CASA to use the notice to retrieve the NYIA assessments and then proceed to assess whether eligible for PCS or CDPAPt. But.. if they are a dual eligible and not in a hospice program, or in OPWDD, TBI or NHTD waiver - they are probably only eligible for 8 hours/WEEK of Housekeeping services from CASA. T

(2) If you applied to HRA for Immediate Need services - PCS or CDPAP via eFax (917) 639-0665 - you should not have to contact the HRA Home Care Services Program/CASA after the NYIA assessessments -- because NYIA should notify CASA of the outcome of the assessments directly and they should contact you about next steps to decide if you are eligible for services and if so - what is your plan of care.
03 Jun, 2023 132 kb Downloads: 462
MAPDR-05 (08/04/2022) List of Managed Care & Managed Long Term Care Plans in NYC Download
2022-08-04 MAPDR-05 Medicaid Managed Care Plans NYC.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Health and Recovery Plan Managed Care Plans (HARP)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA) IDD

Updated August 4, 2022 (current on HRA site as of 5/31/23)
31 May, 2023 129 kb Downloads: 60083
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: 9758
List of 2023 Medicare Special Needs Plans (SNPs) in NYS Download
2023 New York State Special Needs Plans updated 3-6-23.xlsx
List of 2023 Medicare Special Needs Plans (SNPs) in NYS. Indicates whether plan is aligned with and part of a Medicaid Advantage Plus (MAP) plan (includes MLTC plan in same plan) or an IB-Dual plan (Integrated benefit - Dual) which is a type of a Medicaid managed care plan for people who have Medicare. These plans are subject to Default Enrollment. See http://health.wnylc.com/health/entry/226/. List updated in March 2023 with new plans and counties using Default Enrollment.
06 Mar, 2023 74 kb Downloads: 658
NYLAG PowerPoint on NY Independent Assessor - Feb. 2023 Download
NYIA Webinar CLE Slides Handout 2-2023.pdf
Presentation given in webinar conducted by NYLAG Evelyn Frank Legal Resources Program on Feb. 8, 2023 on the NY Independent Assessor.
15 Feb, 2023 1.99 mb Downloads: 849
NYLAG PowerPoint on NY Independent Assessor - and other Home Care Changes 2022 Download
NYLAG NYIA for CDPAANYS 10-2022 - corrected.pdf
NYLAG Slides on NY Independent Assessor - and other Medicaid and Home Care Changes 2022 - current as of 10/27/2022, based on regulations and DOH policies slides posted at https://www.health.ny.gov/health_care/medicaid/redesign/nyia/repository/index.htm \ See more info and updates at http://www.wnylc.com/health/news/85/
05 Dec, 2022 384 kb Downloads: 2338
Know Your Rights: Is Your MLTC Plan Closing? Know Your Rights - August 2022 Download
MLTC Plan Closings (2022).pdf
Fact Sheet by NYLAG Evelyn Frank Legal Resources Program explaining the "transition rights" of MLTC members when their MLTC plan closes.
01 Aug, 2022 1.01 mb Downloads: 1877
Fact Sheet on Continuity of Care or Transition Rights - After You Enroll in an MLTC Plan (updated 8/1/22) Download
Transition Period changes Fact Sheet - updated 8-1-22.pdf
If you received Immediate Need home care, or your MLTC plan closed, or you were disenrolled from your MLTC plan involuntarily, you are required to enroll in or switch MLTC plans. You have "continuity" or "transition" rights in your new MLTC plan. Learn about those rights and current changes in the rules for what happens when the "Transition Period" ends after 90-120 days.
01 Aug, 2022 950 kb Downloads: 3055
How To Use the NY Independent Assessor Information Sharing Form Download
NYIA Authorized Rep Form - How To Complete + Submit (NYLAG - 7-7-22).v2.pdf
The New York Independent Assessor (NYIA) has posted an "Information Sharing Consent Form" for you to authorize release of health information to NYIA. The consent form allows NYIA to contact your doctors and other medical providers as needed for them to assess your eligibility to enroll in a Managed Long Term Care (MLTC) plan, or for you to obtain Medicaid personal care or Consumer-Directed Personal Assistance (CDPAP) services from your local Medicaid office or Medicaid health plan. You can also designate an authorized representative who may act on your behalf when interacting with NYIA.

To find the form, go to https://nyia.com/en/consent. This guide explains how to complete, e-sign and submit the form online, which is not easy. It also explains how to print a blank form. A PDF copy is also attached to this Guide.
27 Jul, 2022 2.73 mb Downloads: 3030
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