Combined in one PDF is March 2015 State directive to MLTC plans requiring use of new templates for notifying member of reductions, denials, and terminations of services. Templates should be used by mid-May 2015. PDF includes Directive plus TWO new notice templates and the state's EXAMPLES of how the two templates are used. Also included is a sample of notice that MLTC plans sent to all members in June 2015 notifying of elimination of requirement to "exhaust" internal appeals before requesting fair hearing

Sample notice received by MLTC enrollees (partial cap plans only) in June 2015 explaining that internal appeals are no longer required when a plan takes adverse action.

Data compiled from CMS site https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Plan-Items/Monthly-Enrollment-by-Plan-2015-05.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending

and DOH site http://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/

This is the form used by the New York City Human Resources Administration for doctors to request personal care services through Medicaid for people who are excluded or exempt from Managed Long Term Care. This means it is for people in the OPWDD, TBI or NHTDW waivers, who require only Housekeeping services of up to 8 hours/week or who are under age 21. The form was updated 12/2014. This is a fillable version. THe original PDF can be downloaded at http://www.nyc.gov/html/hra/downloads/pdf/services/micsa/m_11q.pdf.

NYLAG Evelyn Frank Program "Appendix" of documents on MLTC and FIDA for CLE 4/20/15 - includes helpful lists of plans, forms, and a Troubleshooting guide.

PowerPoint Presentation by NYLAG Evelyn Frank Program on FIDA and MLTC 4/23/2015.
Updated version of presentation in live CLE conducted APril 20, 2015

Esta presentación fue realizada el 13 de Abril 2015 en una organización local en Brooklyn para los residentes de ese edificio. La presentación es en español. Esta presentación se enfoca en los temas de Medicare, Medicaid, planes de cuidado a largo plazo (MLTC), y planes de doble ventaja totalmente integrado (FIDA).

Debe de usar estos materiales con la grabación sobre FIDA.

This presentation took place on April 13th, 2015 for local Brooklyn residents residing in senior housing. The presentation was conducted in Spanish. The presentation discussed Medicare, Medicaid, Managed Long Term Care plans (MLTC), and Fully Integrated Dual Advantage plans (FIDA).

Please view the powerpoint in conjunction with the Spanish recording of the presentation.

On May 22, 2014, DOH provided Consumer advocates with drafts of notices regarding passive enrollment in FIDA to begin fall 2014. This is the Consumer coalition's proposed revision of NOTICEs 3 and 4 (60-day and final 30-day notices before Passive Enrollment).

Fact sheet written by New York Legal Assistance Group Evelyn Frank Legal Resources Problem addressing common problems encountered by those trying to enroll in MLTC plans, especially where they have a spend-down OR are trying to leave a nursing home. Learn how to avoid delays in enrollment. Includes helpful forms, focused on NYC but can be adapted statewide (updated April 15, 2015)

"Conversion" Form used in NYC by MLTC, PACE and Medicaid Advantage Plus plans to ask HRA Medicaid program to convert the Medicaid eligibility codes and allow them to enroll an individual who has been determined eligible for Medicaid into MLTC plan. Most commonly needed for people with a spend-down. They may have been found eligible for Medicaid but Medicaid is not activated until spend-down is met OR until HRA has processed this "conversion" to activate Medicaid even if spend-down is not met. Also see MLTC Frequently Asked Questions HCSP Quick Reference- REVISED 11-13-2013.pdf posted on this site