Form renamed in 2014 - formerly known as Request for Reconsideration. 2 versions of form are in this PDF - One is "Non-EDITs" and one is "EDITS."

Notifies outside submitters of changes to HRA’s process for submitting case reconsideration and reapplication requests. Both processes are being standardized across the Medical Insurance and Community Service Administration’s (MICSA’s) Divisions, with the exception of the Nursing Home Division. The reconsideration process is also being renamed as a
Request for an Agency Conference. MICSA’s Reconsideration Request form (MAP-3069b) has been renamed to “Request for an Agency Conference.” It replaces forms MAP-751, MAP-751a, MAP-751h and MAP-751j which
were previously used by various MICSA divisions to accept requests for case reconsiderations.

Presentation from NYC Human Resources Administration to managed care plans on the NYC process for helping managed care plans work with their members to renew Medicaid coverage. Describes renewal timeline in general, as well as special weekly data file (RS) sent to plans to help them identify members who need follow-up. May 14, 2012.

reminder that renewal status information is available for Medicaid clients through HRA’s Medicaid Helpline (888-692-6116). This status is available through an Interactive Voice Response System (IVRS) and is updated daily. By entering a client’s social security number and date of birth into IVRS, the caller can obtain information on the status of a client’s renewal:

Whether or not HRA has received a renewal from the client,
Status of HRA’s processing of the renewal and
The eligibility decision if the renewal has been processed.

The system is being upgraded and will, in the next few months, also allow the option of using case number to receive information.

Effectively immediately, the review of assets is limited to the 60-month period immediately preceding the month of institutionalization and application for Medicaid.

For Medicaid recipients who are institutionalized for long-term nursing home care or receiving more than 29 days of rehabilitation services, the look-back period consists of the 60 months preceding the month of institutionalization.

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.

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)

This is the cover sheet to used for MLTC NHED

This is the MLTC Provider Relations Unit cover sheet to be used