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Elderpan, Inc. Adverse Determination Policy MAP - NY
Elderplan MAP AppealsDRAFT.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy is labeled "draft" and has no effective date.
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05 Feb, 2013
89 kb
Downloads: 5457
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Fidelis Appeals of Adverse Determinations (and Grievance information) MAP - NY
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.
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05 Feb, 2013
85 kb
Downloads: 8660
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HealthFirst CompleteCare Notice of Action and Appeals
Healthfirst MAP Notice of Action and Appeals.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy contains no date.
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05 Feb, 2013
44 kb
Downloads: 4922
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HealthFirst CompleteCare Adverse Determinations Policy - MAP
Healthfirst MAP Adv Determination & Adv Org Determinations 1.pdf
Policy obtained January 2013 through FOIL Request to DOH. Policy last revised in Sept. 2011.
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05 Feb, 2013
31 kb
Downloads: 4602
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AmeriGroup Appeals of Adverse Determinations - Policy MLTC
Amerigroup Appeals of Adverse Determinations - MLTC - NY.pdf
Policy Obtained January 2013 through FOIL Request to DOH, last Revised March 24, 2011
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01 Feb, 2013
103 kb
Downloads: 5151
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NYS Dept. of Health Policy Directive to Managed Long Term Care Plans Jan. 17, 2013 re Transition, Appeal & Aid Continuing Rights
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
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25 Jan, 2013
66 kb
Downloads: 5236
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Sample End-of-exemption letter requiring managed care enrollment - August 2012
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.
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11 Oct, 2012
438 kb
Downloads: 563
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HCSP Central Intake Medicaid Unit HRA
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.
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27 Sep, 2012
611 kb
Downloads: 711
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HRA Medicaid Alert: Mandatory MLTC Update Sept 2012
Medicaid Alert Mandatory MLTC Update 9-6-2012.pdf
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07 Sep, 2012
118 kb
Downloads: 1193
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Final Consumer Comments on NYS DOH Proposal to Manage Care for Dual Eligibles
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.
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07 Aug, 2012
242 kb
Downloads: 3252
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