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.

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.

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/.

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.

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.

Announces change effective April 23, 2017 from LogistiCare to MAS - Medical Answering Services LLC, the same contractor handling much of upstate NYS.

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/

Letter dated Mar. 13, 2017 from NYS Dept of Health to 4000+ members of Guildnet MLTC in Suffolk, Nassau, and Westchester counties, clarifying that Guildnet MLTC is not closing in those 3 counties on June 1, 2017 and that the plan is required to continue providing services to members after that date. See letter for more.

Letter Guildnet is sending to it;s 4,000+ members in Nassau, Suffolk and Westechester counties in Feb and March 2017 stating, "GuildNet will no longer offer Managed Long Term Care (MLTC) services in [county] effective June 1, 2017. It is important that you select a new MLTC plan before May 18, 2017 to assure a smooth transfer to your new plan. You will continue to receive services from GuildNet until your transfer to your new plan is complete." Letter does not explain that if person does NOT transfer to another plan, they may still stay in Guildnet. Nor does letter explain that new plan is not required by State to honor Guildnet's same plan of care and number of hours. NOr does letter give contact info for ICAN ombuds program. icannys.org

This outline describes the evaluation process for someone who is on Medicare and Medicaid (approved or application pending) who requires enrollment into a Managed Long Term Care plan. Revised 12-2016 to include change that CFEEC now valid for 75 instead of 60 days.