Appendix materials provided with NYLAG's webinar on April 24, 2014 providing update on status of Mandatory MLTC initiative in New York State.

PowerPoint presentation used in NYLAG's webinar on 4/24/14 to HIICAP and others.

Coalition to Protect the Rights of NYS Dual Eligibles Comments on State's revised proposal to coordinate Medicare and Medicaid services for dual eligibles, letter dated May 19, 2013. Issues include enrollment of nursing home residents and protections; objections to "passive enrollment" -- auto-assignment of people who don't voluntarily enroll; and incentives for plans to provide long term care services in the community rather than institutions.

This bill would correct two due process violations: (1) The lack of "aid continuing" pending an appeal when a managed care plan reduces or terminates home care or other services -- if the "authorization period" for the services has expired, there is a right to appeal but no right to aid continuing. This provides that aid continuing must be given regardless of whether the authorization period has expired. (2) In Managed long term care, consumers must "exhaust" internal appeals before requesting a hearing. This is not required in mainstream managed care, and results in dismissal of many valid appeals because consumers don't know that they must pursue this interim internal appeal.

State policy implementing expansion of mandatory enrollment of people needing permanent nursing home coverage into managed care and Managed Long Term Care (MLTC) plans. Mandate is to start April 1, 2014, subject to CMS approval not yet given as of March 13, 2014.

Published in March 2014

Practical Guide on getting Medicaid to reimburse for home care expenses incurred during the 3-month retroactive period, and during the pendency of the application, in New York City. Includes citations to pertinent case law and regulations.

Sample unofficial form affidavit, created by NYLAG in consultation with NYC HRA Reimbursement Unit.

After the Federal CMS agency entered a "memorandum of understanding" with NYS to approve the FIDA proposal to manage care for Dual Eligibles, a 3-way contract had to be approved between the State, the Feds and the FIDA plans. THis is the consumer coalition's comments on what protections are needed in this contract.