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Medicaid Managed Care
Elderpan, Inc. Adverse Determination Policy MAP - NY Download
Elderplan MAP AppealsDRAFT.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy is labeled "draft" and has no effective date.
05 Feb, 2013 89 kb Downloads: 5457
Fidelis Appeals of Adverse Determinations (and Grievance information) MAP - NY Download
Fidelis MAP appeals and grievance policy.pdf
Policy obtained January 2013 through FOIL Request to DOH. Document dated August 2009 labeled "draft." For appeals information see page 9.
05 Feb, 2013 85 kb Downloads: 8660
HealthFirst CompleteCare Notice of Action and Appeals Download
Healthfirst MAP Notice of Action and Appeals.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy contains no date.
05 Feb, 2013 44 kb Downloads: 4922
HealthFirst CompleteCare Adverse Determinations Policy - MAP Download
Healthfirst MAP Adv Determination & Adv Org Determinations 1.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy last revised in Sept. 2011.
05 Feb, 2013 31 kb Downloads: 4602
AmeriGroup Appeals of Adverse Determinations - Policy MLTC Download
Amerigroup Appeals of Adverse Determinations - MLTC - NY.pdf
Policy Obtained January 2013 through FOIL Request to DOH, last Revised March 24, 2011
01 Feb, 2013 103 kb Downloads: 5151
NYS Dept. of Health Policy Directive to Managed Long Term Care Plans Jan. 17, 2013 re Transition, Appeal & Aid Continuing Rights Download
MLTC Policy 2013 01 17 Aid Continuing.pdf
Directive issued by the State to MLTC Plans re Transition Requirement required by Sec. 28(d) of the CMS Special Terms & Conditions of the waiver approving mandatory MLTC at http://www.health.ny.gov/health_care/medicaid/redesign/docs/partnership_amendment_stc.pdf
25 Jan, 2013 66 kb Downloads: 5236
Sample End-of-exemption letter requiring managed care enrollment - August 2012 Download
redacted managed care enrollment etter 8-7-12.pdf
Many people who used to be exempt from mandatory enrollment in Medicaid managed care have been receiving notices in summer and fall 2012 telling them that their exemption has ended, and that they now have 30 days to enroll in a managed care plan. This type of managed care is sometimes called "mainstream" managed care and is for Medicaid recipients who do not have Medicare. It is different from mandatory managed long term care, which is being implemented in NYC in October 2012 for dual eligibles -- those who have Medicaid AND Medicare -- who need Medicaid home care. This is a sample notice used in NYC in August 2012.
11 Oct, 2012 438 kb Downloads: 563
HCSP Central Intake Medicaid Unit HRA Download
HCSP Central Medcaid Unit HRA.pdf
This letter is from HRA and it provides information about the process for filing new Medicaid applications for individuals who will be seeking personal care services.
27 Sep, 2012 611 kb Downloads: 711
HRA Medicaid Alert: Mandatory MLTC Update Sept 2012 Download
Medicaid Alert Mandatory MLTC Update 9-6-2012.pdf
07 Sep, 2012 118 kb Downloads: 1193
Final Consumer Comments on NYS DOH Proposal to Manage Care for Dual Eligibles Download
Letter from beneficiary advocates re NYS dual eligible demonstration 6-30-12 pdf.pdf
These comments were filed with CMS June 30, 2012, after DOH filed its revised proposal for managed care for dual eligibles.
07 Aug, 2012 242 kb Downloads: 3252
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