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HRA-MAP 931Y E-Fax Medical Bills Cover Sheet (5/7/09)
MAP-931Y_E-Fax_Medical_Bills.pdf
HRA Medicaid Fax Cover Sheet to Fax medical bills to meet spend-down
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02 Jun, 2009
79 kb
Downloads: 24887
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Form MAP-252F - AIDS or AIDS Related Complex Medical Report
MAP-252F AIDS Medical Report.pdf
Addendum to Form LDSS-486T. This form is used by NYC HRA to establish that someone is disabled by reason of HIV/AIDS. Rev. 6/25/03.
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29 May, 2009
293 kb
Downloads: 4199
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HRA Medicaid Alert: Pooled Trust Submissions
HRA Medicaid Alert SNT 4-26-06.pdf
Dated 4/26/06.
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29 May, 2009
47 kb
Downloads: 6295
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Miller v. Bernstein settlement, Supreme Court, N.Y. County, May 11, 1978
Miller v. Bernstein.pdf
At paragraph 7 of the Order, HRA agrees to ensure that its procedures shall determine an applicant's eligibility for home care services within 30 days of submission of the physician's order (now known as the M11q).
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18 May, 2009
208 kb
Downloads: 7940
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Form M-27r - NYC HRA Nurse's Assessment Visit Report (8/07/02)
Nurses Assessment Visit report used in NYC.PDF
This copy of the form was completed by NYC HRA for an in-service training conducted by HRA for nurses that do these assessments. Thus this is a model form. Also see the HRA Instructions for the form.
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18 May, 2009
365 kb
Downloads: 11698
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Resource Attestation and Documentation Chart
Resource Documentation.pdf
This chart, produced by HRA, explains the different types of documentation required of an applicant's resources (aka "assets") for the three different levels of coverage provided by New York State's Medicaid program. It also explains which services are covered for each of the three levels.
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10 Mar, 2009
31 kb
Downloads: 16605
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Homecare Reimbursement Worksheet
Reimbursement Worksheet.xlt
This Excel template was created by Selfhelp to duplicate the worksheet used by the NYC Homecare Reimbursement Unit. Having it in Excel makes it easier to complete, but it prints out to look exactly like the one distributed by the City.
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19 Feb, 2009
21 kb
Downloads: 10812
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Home Care Reimbursement Form
Reimbursement Form.pdf
This form is used by the NYC Homecare Reimbursement unit
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19 Feb, 2009
11 kb
Downloads: 15772
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