Update about the Special Income Standard for Housing Expenses for Individuals
Discharged from a Nursing Facility and who Enroll into the Managed Long Term Care Program - see article at http://www.wnylc.com/health/entry/212/

Letter from Alan Morse, CEO of Guildnet, dated 8/21/18 to Guildnet employees stating that Board decided the previous day to close Guildnet effective 12/1/18. States that the plan will be working closely with the State Dept. of Health on the transition of its members to other MLTC plans. Does not state that the Dept. of Health has approved the closure.

Memo dated June 22, 2018 to Member Council of Independence Care Systems stating that closure of ICS MLTC plan would likely be announced in early fall, 2018, and that members would receive 90 days notice to choose another plan, or they would be assigned to VNS Choice. The memo states, "Members will be guaranteed the same level of care (continuity of care) for at least 120 days or until a new assessment is done." The memo states, "It is in each ICS member's best interest to stay at ICS until notification comes from DOH because the extended continuity of care will only be offered to people at ICS at the time of notification."

Fact Sheet on New Rules for Appealing Actions by Medicaid Managed Care and MLTC Plans - Starting May 1, 2018 - by NYLAG Evelyn Frank Legal Resources Program

Compilation of regulations, sample notices, forms, advocacy documents, fact sheets, and online references for CLE Webinar conducted by NYLAG EFLRP on April 18, 2018 on the new Appeals REquirements for Medicaid Managed Care as Implemented in NYS Effective May 1, 2018 (amended slides 5 and 7 4/22/18)

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/

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.

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

NYLAG Testimony on NYS FY 2018-19 Budget - Joint Hearing of the Senate Finance and Assembly Ways and Means Committees - discusses spousal refusal and spousal impoverishment proposals, Managed long term care changes, and other proposals in NYS proposed budget.

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.