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Medicaid Managed Care
Form to Designate Representative to Request Managed Care/MLTC Appeal or Hearing (Rev. 4-16-18) Download
AUTHORIZATION – Medicaid Managed Care Requests (2018-04-16).pdf
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/
16 Apr, 2018 261 kb Downloads: 4850
NYS Dept. of Health Webinar Powerpoint about New Appeals Rules in Managed Care and MLTC that Start May 1, 2018 Download
Public Informational Webinar 42 CFR 438 Service Auth and Appeals March 2018.pdf
Powerpoint from a public webinar DOH held on Mar. 28 and 30, 2018. DOH has stated that the webinar and slides will be posted for viewing, but as of April 11, 2018 they are not yet posted. As a public service NYLAG is posting the slides from the presentation.
11 Apr, 2018 311 kb Downloads: 4289
NYLAG Webinar CLE Announcement on "Exhaustion" - New Managed Care Appeal System - April 18, 2018 Download
Exhaustion Webinar - CLE Registration Form.pdf
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
27 Mar, 2018 260 kb Downloads: 2942
NYS DOH Model Managed Care/MLTC PLAN APPEAL DECISION Reducing Services - Effective March 1, 2018 Download
Final FAD With AC 11-20-17.pdf
The "Final Adverse Determination" template that NYS DOH has provided to Medicaid managed care and MLTC plans for Plan Internal Appeal Decisions affirming a proposed reduction of services. This notice must be used after March 1, 2018, when embers must first request an internal appeal and wait until that is decided before they may request a fair hearing. See more here http://www.wnylc.com/health/news/80/. This "Final Adverse Determination" will advise the member of the right to request a fair hearing with aid continuing.
26 Dec, 2017 679 kb Downloads: 3913
NYS DOH Model Managed Care/MLTC Notice Reducing Services - Effective March 1, 2018 Download
Final IAD With AC 11-20-17.pdf
The notice template that NYS DOH has provided to Medicaid managed care and MLTC plans for reducing services after March 1, 2018, on which date members must first request an internal appeal and wait until that is decided before they may request a fair hearing. See more here http://www.wnylc.com/health/news/80/. A sample of a completed notice is posted at http://www.wnylc.com/health/download/644/ - this is an unofficial sample using hypothetical facts, created by NYLAG for illustration.
22 Dec, 2017 738 kb Downloads: 3908
Sample of Model Notice of Reduction for Managed Care/MLTC Plans Reducing Services - After 3/1/18 Download
Final IAD With AC 11-20-17 Reduction Sample UNOFFICIAL (NYLAG).pdf
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/.
22 Dec, 2017 691 kb Downloads: 3952
State DOH Letter to Former Guildnet Members in LI, estchester 9-29-17 - May ask to Restore Hours Download
2017.10.16 DOH letter Guildnet redacted updated.pdf
Letter from State DOH to people who were in Guildnet MLTC plan in Nassau, Suffolk and Westchester counties and moved to another plan after Mar. 20, 2017. They must call NY Medicaid Choice before Dec. 29, 2017 to ask for their hours to be restored to the amount Guildnet had authorized, if the new plan reduced their hours.
16 Oct, 2017 81 kb Downloads: 3516
Letter from North Shore LIJ MLTC Plan to members, dated 9/22/17, that plan closing 12/31/17 Download
North Shore LIJ - Letter to members closing redacted.pdf
Letter from North Shore LIJ MLTC Plan to members, dated 9/22/17, that plan closing 12/31/17. Informs member that unless chooses and enrolls in a different plan before 11/10/17, will be auto-assigned to Centers Plan for Health Living effective 1/1/18.
09 Oct, 2017 2.04 mb Downloads: 4732
NYC HRA Medicaid Alert 2017-04-26 Change in Medicaid Transportation Contractor in NYC for Medicaid Managed Care and Fee for Service Medicaid Download
2017-04 Medicaid Alert re Transportation for FFS and MMC New Company.pdf
Announces change effective April 23, 2017 from LogistiCare to MAS - Medical Answering Services LLC, the same contractor handling much of upstate NYS.
08 Jun, 2017 192 kb Downloads: 3587
Chart of Enrollment in MLTC Plans - Nassau, Suffolk, Westchester - March 2017 Download
Guildnet market share 11-2016 and 4-2017.pdf
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/
23 May, 2017 263 kb Downloads: 3014
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