Fact Sheet prepared by the NYLAG Evelyn Frank Legal Resources Program explaining tips on how to request new or increased services from a Medicaid managed care or MLTC plan, including the timeline in which the plan must process the increase. Russian translation posted at http://www.wnylc.com/health/download/782/

If the request is denied, see separate Fact sheet on appealing denials. http://www.wnylc.com/health/download/654/.

Russian Translation of Fact Sheet prepared by the NYLAG Evelyn Frank Legal Resources Program explaining tips on how to request new or increased services from a Medicaid managed care or MLTC plan, including the timeline in which the plan must process the increase. English version is at http://www.wnylc.com/health/download/723/

If the request is denied, see separate Fact sheet on appealing denials. http://www.wnylc.com/health/download/654/

This Alert is to advise Medicaid Providers, Hospitals, Client Representatives, Community Based Organizations, Certified Home Health Agencies(CHHA), and Advocates, that the Home Care Services Program (HCSP) has created an email inbox to allow for the submission of inquiries related to HCSP Medicaid case transactions using hcspinquiries@hra.nyc.gov. Allowed inquiries/transaction include demographic changes, address updates, pooled trust review, county-to-county transfer requests, Medicare Savings Program and coverage updates. This email is NOT FOR SUBMITTING APPLICATIONS or documents related to an application. Please read Alert for required information.

Comments filed on May 5, 2021 in response to the State Dept. of Health's proposal to CMS on how it will implemenet the 30-month Lookback, that was enacted in the NYS FY 20-21 Budget, and applies to MLTC enrollment and all other home care and the Assisted Living Program. The State's proposal can be viewed at https://health.ny.gov/health_care/medicaid/redesign/mrt2/proposals/30-month_lookback-final.htm

Official template for NYS Medicaid Advantage Plus plans to deny an initial request for prior approval for a service or for an increase in a service. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.

State template for final decisions after the internal plan appeal in the new integrated appeal procedure that began in 2020 for MAP plans. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.

Redacted sample of a letter sent in late March 2021 to 789 members of the Healthfirst Medicaid Advantage Plus plan explaining the plan's mistake in failing to forward their case for a hearing, as required in the new Integrated Appeal process for MAP plans that began 2020. Read about this new appeal process and more about this letter at http://www.wnylc.com/health/entry/225/

Letter to Governor Cuomo and leaders of the legislature calling for NYS Budget initiatives that will ensure access to home care to prevent unnecessary institutionalization -- COVID-19 has been a wake-up call for the need to avoid nursing home placement when ever possible.

NYLAG's comments submitted on the 2nd round of proposed State regulations implementing 2020 changes in State law restricting eligibility for personal care, CDPAP and MLTC enrollment, and changing the procedures for how Medicaid home care services are assessed. The proposed State reg can be found at https://health.ny.gov/health_care/medicaid/redesign/mrt2/express_terms_summary.htm. The NYSBA Elder Law & Special Needs Section comments are also attached to and referenced in the NYLAG comments.

NYS DOH has requested that CMS change the 1115 waiver that governs MLTC and managed care in 2 ways. (1) Restrict enrollment in MLTC to those meeting new 2- or 3- ADL requirement enacted in State budget in April 2020; (2) Keep people in mainstream Medicaid managed care plans when they start getting Medicare, if they are enrolled in a Dual-Special Needs Plan. They could opt out but otherwise would automatically stay in managed care. See waiver request at https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/2aea7cd. NYLAG comments posted here