In This Article
1A Special "E14" Waivers to Prevent Cutting Off Medicaid for People who are Eligible
1B More about the Unwinding in NYS - Official Guidance & Fact Sheets
2a. The Two COVID Maintenance of Requirements - one requiring continuous Medicaid coverage and the other banning states from implementing new eligibility restrictions, like the lookback.
2b. NO MEDICAID CASE CLOSINGS/ Automatic Renewals - the protections since March 2020 continue until consumer has gone through their first Renewal starting in March or April 2023. No cases can be closed until July 1, 2023 - and then only after a renewal is completed.
2.c..NYS and NYC Directives on Medicaid applications, procedures, etc.
2.d. Applications - Easements making it easier to apply - less documentation These end July 1, 2023.
Medicaid Home Care - NYS Dept. of Health Policies and Procedures & Consumer Advocacy
NYS OTDA Fair Hearings- Phone Hearing Demonstration - see this article
How Covid-19 Federal Stimulus Payments Impact SSI, Medicaid & other Benefits - including for Nursing Home & Adult Home Residents? See this article
Beginning in March 2023, Medicaid recipients in NYS began receiving “renewal” packages – forms which they must complete and return to the local Medicaid office to verify their current income and financial resources. Local Medicaid offices, such as HRA in NYC, use these renewal forms to determine if the consumer is still eligible for Medicaid or a Medicare Savings Program, and to determine the amount of their “spend-down” if their income is above the Medicaid limit.
The annual renewal process had been paused for three years since March 18, 2020, when Congress required all States to continue Medicaid for everyone who Medicaid on March 18, 2020 or obtained it since then. See here about the federal "Maintenance of Effort" requirements. Since Medicaid could not be cut off, even for someone who was no longer eligible, there was no point in processing the renewals. Medicaid was simply automatically extended for one year with the same spend-down, even if normally the spend-down would have increased. See more about the pause as implemented in NYS here.
But beginning July 1, 2023, Medicaid can be cut off if someone fails to return a completed renewal or required documentation, or if the renewal shows they are no longer eligible. Also, one’s spend-down can be increased after a renewal is processed. The good news in NYS is that the in 2023 the income and asset limits increased for non-MAGI Medicaid - which covers people age 65+, disabled and blind. This means most people should see their spend-down reduced or even eliminated in these renewals.
No Medicaid recipient's coverage should be reduced or terminated before July 1, 2023, unless they died, moved out of state or voluntarily stopped their own coverage. Starting July 1, 2023, coverage can only be reduced or terminated based on a review of a completed renewal after 10-day advance written notice is mailed to the consumer with the right to request a fair hearing.
Renewals will be sent in batches over 12 months, so Medicaid must continue for all those who haven't yet received their renewals. See here about how to estimate when your renewal will be sent to you.
Nationally, lifting of the moratorium that prohibited closing Medicaid cases is called the “unwinding” of the Public Health Emergency. States must process renewals for every Medicaid recipient in batches over 12 months. In NYS, this means processing more than 9 million renewals in one year – both by local Medicaid offices and also by the NY State of Health (“NYSOH”), the online marketplace that administers “MAGI” Medicaid for those under 65 who do not have Medicare and also Child Health Plus and the Essential Plan.
Click here for links to NYS guidance and fact sheets about the unwinding.
SEe the NYS Unwinding Dashboard here.
Because this huge crush of renewals is so burdensome to the government, and because the stakes are so high for consumers who might mistakenly lose Medicaid in the deluge (see this NPR story), the State has obtained some “E14 waivers” from CMS, the federal Medicaid agency, intended to ease these burdens. Also, many recipients have not returned a renewal for nearly 3 years -- and many only applied for Medicaid during the pandemic so never had to do a renewal. This will be new to them - creating more risk that some won't be able to navigate the process.
These E14 waivers are described below and also can be found in the NYS Unwinding Dashboard here.
Nearly 100,000 New Yorkers first enrolled in Medicare during the pandemic, based on age or disability, and already had MAGI Medicaid on NYState of Health. Before COVID, new Medicare enrollees were transferred from NYSOH to the local Medicaid office, which switched them to Non-MAGI Medicaid with its stricter rules. During the pandemic, Medicaid for these new Dual Eligibles stayed on NYSOH.
Now, during the “unwinding,” most of their Medicaid cases will remain on NYSOH, which will process their renewals under “MAGI” rules, even though they now have Medicare. However, there are exceptions. Medicaid will be transferred to the local Medicaid office if income is above the Medicaid limit, since only local Medicaid offices offer the opportunity to “spend down” excess income, or to use spousal refusal, pooled trusts or many other special Medicaid budgets described here. Also, if the new Dual Eligible is receiving Medicaid personal care, CDPAP, private duty nursing, or adult day care from their Medicaid managed care plan, they will now be required to enroll in an MLTC plan. In order to enroll in MLTC, their Medicaid must be transferred to the local Medicaid office.
Most of those new Dual Eligibles whose Medicaid remains on NYSOH and do not receive home care or other long term care services, upon their Medicaid renewal, will be disenrolled from their Medicaid managed care plans, which are not designed for people with Medicare. They were allowed to stay in these plans during COVID only. They will now have “regular” or “Fee for Service” Medicaid as secondary insurance to their Medicare. There are exceptions here too. Some who became enrolled in Medicare during the pandemic were “default enrolled” into Medicare Dual Special Needs Plans (“D-SNP”) operated by the same insurance plan that operates their Medicaid managed care plan.
Aid Continuing means that the threatened reduction or discontinuance cannot take effect until the hearing is held and a decision issued. This waiver mitigates some of the harm to appellants from continuing delays in scheduling hearings. It doesn’t help those appealing a denial of an increase in home care or denial of a Medicaid application. However, those denied an increase in home care can benefit from special relief through the Varshavsky injunction, described here. See more about fair hearings here.
Download the CMS Fair Hearing e14 Waiver Approval
See this article for best practices on completing and submitting Renewals.
APRIL 2023 - In NYC, Renewals can now be filed online! See more here.
NYS opted to start the "unwinding" of the continuous coverage requirements in March and April 2023 -- the latest date allowed by CMS in Jan. 2023 guidance. See CMS’ March 2022 guidance, followed by FAQs in Oct. 2022 and other guidance posted here. See CMS Unwinding Guidance compiled by the National Health Law Program - click here. States must complete renewals within 14 months.
Make sure consumer's address is up to date with the local Medicaid agency! To make sure they receive the mailed renewals! In Dec. 2021, HRA did a mass mailing to all recipients requesting them to update their address to ensure that they receive these renewals. See HRA Alert Dec. 20, 2021, which describes this mailing, which includes Form 751k (fillable) for recipients to report a change of address. Download 751K in various languages here. Fax it to 1-917-639-0837 Also see this HRA Alert June 30, 2023 which provides for protections for consumers whose renewal packets are returned by USPS.
NYS Dept. of Health OFFICIAL UNWINDING INFO:
GIS 23 MA/14 - Updates to Medicaid Renewals and Other Processes in the Unwind Period.
GIS 23 MA/14 Attachment I Sample Notice "MA Extensions Based on SNAP Eligibility"
GIS 23 MA/14 Attachment II ROS SNAP Mitigation Period Process Flow Chart
GIS 23 MA/14 Attachment III SSI-R Unwind Chart
GIS 23 MA/03 - Unwind of the Medicaid Continuous Coverage Requirement Related to the COVID-19 Public Health Emergency and Processing Cases Under Regular Rules.
NYS Dept. of Health May 2023 slides on the Unwinding here and see more about it here.
NYS FLYER -- Learn about the steps to renew your insurance (HRA) (Local Dept. of Social Services outside NYC)
NYS DOH FAQ's About Unwinding updated March 2023 -
If you have Medicaid through NYSofHealth English Spanish Chinese (Simplified) Chinese (Traditional)
See more on the NYS Dept. of Health webpage Important Changes to New York Medicaid, Child Health Plus and the Essential Plan
Medicaid Matters Consumer Fact Sheet about the Unwinding!
Empire Justice Center Updated PHE Unwind Fact Sheet! (Aug 2023)
CMS Unwinding Guidance compiled by the National Health Law Program - click here
In NYC, renewals can now be filed online! See more here.
2.A. TWO COVID laws have had "Maintenance of Effort" (MOE) Requirements. The "unwinding" of these protections is starting. See more about the unwinding below.
The Trump administration in its last days published federal regulations called the Interim Final Rule that chip away at the moratorium on case closings and reductions, allowing states to make some adverse changes on eligibility. NYLAG joined with the National Health Law Program and other organizations opposing this rule. See Kaiser 12/20 article here. Invoking this Trump federal rule, some states downgraded some beneficiaries from Medicaid to the Medicare Savings Program, or shifted QMB eligibility to the less generous SLIMB or QI-1 eligibility, or cut off Medicaid altogether. We commend NYS for not allowing these reductions during the PHE.
In February 2023, a nationwide injunction was issued in a class action Carr v. Becerra, requiring all states to restore Medicaid eligibility if it was cut off or reduced under the Trump regulations. Read more here. HHS has since proposed to amend the regulations (see also here)
FFCRA section 6008(b)(3) says states may not make eligibility standards, methodologies, or procedures for determining eligibility for Medicaid more restrictive than they were on Jan. 1, 2020.
WHEN DOES IT END? Originally, FFCRA said this restriction is in effect until the end of the quarter in which the PHE ends. Under the Consolidated Appropriations Act, (H.R. 2617) these restrictions will end in December 2023. This is one reason why the new 30-month "lookback" for community-based long term care, and the Minimum ADL thresholds for personal care and CDPAP, enacted in April 2020, have been postponed, among other changes. But the separate ARPA MOE requirement delays these changes further.
American Rescue Plan (ARPA) creates a separate Maintenance of Effort Requirement. States cannot restrict eligibility for Home & Community Based Services (HCBS)
NYS DOH has delayed the lookback for home care & the Assisted Living Program to begin no earlier than March 31, 2024. If NYS takes longer to spend the ARPA funds, this may be further delayed until March 31, 2025.
This MOE requirement also bars the state from implementing the new 2- or 3-ADL criteria for personal care, CDPAP, and MLTC enrollment.
WHEN DOES IT END? The earlier of when they spend the federal ARPA funds or March 31, 2025. See this link.
See NYS ARPA website for its spending plan and quarterly reports to CMS.
See CMS full state summaries that provide information on the amount of planned and reported state spending for each state, as of the quarter ending December 31, 2022. As of that date, NYS had spent $1.5 billion out of $5.2 billion planned.
Until a Medicaid or MSP recipient has gone through their renewal in the "unwinding," their Medicaid most continue under the original 2020 guidance implementing the COVID protections. The main State directive is GIS 20 MA/04, updated in GIS 20 MA/11.
No Medicaid recipient's coverage should be reduced or terminated before July 1, 2023, unless they died, moved out of state or voluntarily stopped their own coverage. Even then, coverage can only be reduced or terminated based on a review of of a completed renewal. So if a consumer's renewal isn't until the end of the 12-month cycle in which all 8 million renewals are sent out starting in March and April 2023, their Medicaid cannot be reduced or discontinued until that renewal is completed.
Stenson & Rosenberg -People who lose SSI or Cash Assistance normally have to go through a recertiification process to keep their Medicaid (called the Stenson and Rosenberg procedures in NYS). During the Public Health Emergency and until June 30, 2023, though they may still receive mail asking them to complete and return the renewal forms, their Medicaid should not be discontinued even if they do not to so. After July 1, 2023 these discontinances will re-start.
AUTOMATIC ONE-YEAR EXTENSIONS of ELIGIBILITY - When a Medicaid authorization ended anytime between March 31, 2020 through May 31, 2023, the local district has been required to recertify Medicaid for 12 months, regardless of whether the recipient failed to return the annual renewal forms or respond to requests for information - Medicaid will NOT BE DISCONTINUED. This is also true even if the recipient reported information that would normally make them ineligible for Medicaid, or would increase their spend-down .
See HRA Alert that says authorization periods ending May 31, 2023 will be automatically extended, but the COVID easements pertaining to Medicaid application and renewals are unwinding - see this HRA Alert June 30, 2023
See more about the unwinding here - that will allow discontinuance of Medicaid starting with those whose coverage ends June 30, 2023. See more NYC alerts here.
Those who had MAGI Medicaid and turn 65 during the Public Health Emergency, or become eligible for Medicare based on disability, would normally have their Medicaid transferred from NYSofHealth to the local district, to be redetermined under non-MAGI Medicaid rules. Instead, since March 2020, they have had Medicaid automatically extended for 12 months and have remained on NYSofHealth.
Since March 2020, cases have not been referred to the districts and coverage is just extended by NYSofHealth. They have not have to show that they applied for Medicare, or applied for VA benefits if they are veterans, contrary to the usual rule. But those requirements begin again July 1, 2023.
Some cases must still be referred manually to the LDSS, such as those who need nursing home care or who want MLTC, since institutional Medicaid and MLTC require Medicaid to be authorized by the LDSS -- even if eligibility is based on MAGI. See HRA Medicaid Alert 2015-03-10. Transition Exchange to LDSS - Consumers with Medicaid on Exchange Needing Enrollment into MLTC or HIV SNP
These newl Dual Eligibles individuals are mostly in Medicaid managed care plans. Many have remained in these plans during the emergency, even though they now have Medicare. Normally, they would be dis-enrolled from these plans once they obtain Medicare. If they need Medicaid home care, they request it from their managed care plan.
When these receipients who newly enrolled in Medicare during the PHE go through their "unwinding" renewal on NYSofHealth, they will be disenrolled from their Medicaid managed care plan and be transitioned to regular Medicaid. There are exceptions - they will stay in their Medicaid managed care plan if it is an
"IB-DUAL" plan - a Medicaid plan that is aligned with a Medicare Dual Special Needs Plan (Dual-SNP) offered by the same insurance company. Together, the IB-Dual plan and Dual SNP are considered an integrated care plan. See DOH Integrated Care webpage and this article.
Also, those who received personal care or CDPAP services from their Mainstream managed care plan shoud be transferred to the Local DSS/HRA to process their renewal AND should be transitioned to an MLTC plan for their home care.
"Individuals in the Medicaid Buy-In Program for Working People with Disabilities who have experienced job loss as a result of the COVID-19 emergency must be given a grace period due to loss of work. If applicable, the grace period should be extended for six (6) additional months." GIS 20 MA/04 The DOH 5/20/20 FAQ clarifies that the initial extension is 6 months, and "an additional six-month period will be provided if needed to look for new employment." (FAQ #16). These protections end when the consumer goes through their "unwinding" renewal in the year beginning March 2023. See GIS 23 MA/03.
Medicaid may not be discontinued for "whereabouts unknown" if correspondence from the LDSS/HRA is returned. GIS 20 MA/04 p. 3. The renewals starting in March 2023 in the "unwinding" have special protections for returned mail. See GIS 23 MA/03.
If had active Medicaid because of "Aid Continuing" on March 18, 2020, this must continue GIS 20 MA/04 p. 6. The May 20, 2020 DOH FAQ clarifies that "your Medicaid coverage will continue under Aid to Continue status even if you lose your fair hearing." (FAQ #7)
Surplus/Spend-down Cases -- Initially in the PHE, if the spend-down was met in March, the LDSS/HRA put up coverage for 6 months. That is no longer true. Bills must be submitted to meet the spend-down. NYC Recipients who have problems submitting bills should follow the instructions on the HRA policy - and elsewhere contact their local district office. The amount of the spend-down may be reduced, but not increased, during the emergency (GIS 20 MA/04) See May 20, 2020 DOH FAQ FAQ #10 for more about spenddown in the PHE.
In NYC (from HRA): 2021-10-29 Medicaid Surplus Coverage Update – During the Covid Health Emergency, surplus consumers must continue to meet their surplus requirement and, upon payment, should contact the Surplus Hotline to report that a payment was made. If consumers cannot make a surplus payment or their income have gone down, they should have their case re-budgeted. If they are unable to submit payment because of health issues related to Covid-19, such as quarantine or hospitalization, they can attest by calling the Surplus Hotline.
NYS Directives
NYS Dept. of Health GIS 23 MA/03 - Unwind of the Medicaid Continuous Coverage Requirement Related to the COVID-19 Public Health Emergency and Processing Cases Under Regular Rules (Feb. 15, 2023)
NYS Dept. of Health Jan. 13, 2023 Memo and Timeline for Unwinding the PHE
NYS Dept. of Health Dec. 15, 2020 GIS 20 MA/11 - Update to GIS 20/MA 04 - Coronavirus (COVID-19) - Medicaid Eligibility Processes During Emergency Period
NYS Dept. of Health - May 20, 2020 Medicaid Coverage through Your Local Department of Social Services (LDSS) during the Coronavirus Emergency: English - (PDF)
NYS Dept. of Health - April 2, 2020 GIS 20 MA/04 – Coronavirus (COVID-19) – Medicaid Eligibility Processes During Emergency Period
NYS Dept. of Health - March 21, 2020 Covid 19 Guidance on Medicaid Eligibility & Enrollment
Click here for NYS DOH directives for health care providers
New York City Directives - also see NYC HRA Health Assistance Webpage
NYC HRA 06/30/2023 Unwinding of the Medicaid Continuous Coverage Requirement
NYC HRA 01/25/2023 Medicaid Program Modifications COVID-19 Emergency (update to 3/27/20, 6/22/20, 8/10/20, 09/09/20,12/17/20, 1/13/21, 2/22/21, 3/25/21, 4/27/21, 5/21/21, 6/14/21, 8/4/21, 8/23/21, 11/5/21, 12/06/21, 01/24/22, 03/14/22, 04/14/22, 05/09/22, 07/05/22, 09/08/22,10/25/22 & 12/08/22 alerts)
01/25/23 extends automatic renewals to cases ending through May 2023. COVID easements are ending.
NYC HRA 12/30/21 - See HRA Alert explaining mass mailing to all Medicaid recipients telling them to report a change of address that occurred in the last 2 years. Change should be reported with Form 751k (fillable) or in varioius languages here. Updating addresses is important because once the pandemic is declared over, all recipients will receive Renewal notices by mail. Without an updated address, they will not receive these renewals, and Medicaid could be discontinued.
NYC HRA 08/30/2021 REVISED Fax Submissions to MICSA & HCSP (revises earlier alerts)
NYC HRA 5/28/2020 Defective Renewal Notices During Covid-19 Emergency (See this update re HRA sending 32,056 case closing notices in error for renewals due May 2020).
Transfers of assets and asset eligibility on nursing home applications - may attest through 6/30/23. GIS 20 MA/04 p. 3
May attest re Retirement accounts and annuities thru 6/30/23, but DOH FAQ says, "however you may be required to provide proof at renewal."
MAY NOT ATTEST TO these - must submit documentation (per DOH FAQ May 20, 2020) - Q. 11,
Citizenship and Immigration Status - GIS 20 MA/04 p. 3 - DSS/HRA will try to verify status through SSA data match. If that can't be done and documentation is needed, DSS/HRA will put up 90 days of coverage while applicant has an opportunity to obtain documentation. If the emergency period has not ended after 90 days, it will be extended for another 90 days if applicant still hasn't obtained documentation. See 10 OHIP ADM-8 for procedures "to give a reasonable opportunity period to consumers who are attesting to be U.S. Citizens."
Pre-Paid Burial Agreements - must submit proof that the agreement is irrevocable.
Trusts - including Pooled Income Trusts - Copies of all trust documents are still required. See this article.
Individuals turning 65 do not have to apply for Medicare, SSA or VA benefits as a condition of eligibility (for applications filed thru 6/30/23)
Do not have to respond to reports received by local DSS after 3/1/20 -- that a Social Security number could not be verified, or that a resource appeared on an electronic match or could not be verified
No proof of Third Party insurance coverage is required - local districts are not required to makenew cost effective determinations for possible reimbursement if sufficient information is not available. But if insurance ends, district may stop payment of premium. GIS 20 MA/04 p.6
WHERE TO APPLY - Every local DSS has its own procedures.
NYC prefers e-FAXed applications - 3 different fax numbers depending on who is submitting the app and if it's for "Immediate Need" home care
E-FAX applications to 917-639-0732 (For general public who are not authorized submitters) HRA PREFERS this to mailing!
IMMEDIATE NEED HOME CARE applications ONLY - 1-917-639-0665.
Authorized Submitters (C-REPs) ONLY can fax to 917-639-0731
See more NYC fax numbers at NYC HRA 08/30/2021 REVISED Fax Submissions to MICSA &
If a signature on the application cannot be obtained from the applicant/recipient (A/R) or the A/R’s spouse, Attachment 1 to 17ADM-02 - Asset Verification System , “Submission of Application on Behalf of Applicant” DOH-5147 (MAP-3044 for NYC A/Rs), must be signed by the person signing and submitting the application and must accompany the application. In Section C of the DOH-5147 (Reason for Submission/Section II of the MAP-3044) “COVID-19” should be noted if the A/R cannot sign the form due to access issues. All information must be completed on the application. BUT see this HRA Alert 6/30/23 that HRA will no longer accept MAP-3044 that list COVID-19 as the reason for incapacity.
If a signature can be obtained from the applicant/recipient, Section D (Authorization to Apply for Medicaid on Applicant’s Behalf) of the DOH-5147 form should be signed by the A/R authorizing another person or the facility to apply on behalf of the individual.
Aged, Blind and Disabled (ABD) Facilitated Enrollers (FE outside NYC) (in NYC) who are unable to assist individuals in person during this time will be following a similar process with one exception: the DOH-5147 form (or MAP-3044 form) will be signed by the applicant authorizing the ABD.
from GIS 20 MA/04 p.4- 5 and see DOH FAQ #2
Requests for Information while Application pending - from GIS 20 MA/04 p. 5
... During this period, if an application or Supplement A is missing required information, the district should contact the applicant, authorized representative or the person submitting the application on behalf of the applicant, if applicable, by email or telephone to obtain the necessary information. The district does not need to receive the information in writing and can accept information verbally. The eligibility staff should note in the case record any information obtained by phone and make a notation in the case record that information was received verbally due to COVID-19 circumstances.
If after three (3) attempts, the local district is unable to contact the individual, the individual’s authorized representative or the person who submitted the application on behalf of the applicant (including when no response is received from an email contact), the local district must send a written request to the individual and the authorized representative or person submitting the application on behalf of the applicant, for the missing information. The request sent must include a response due date of no less than 10 days. Information concerning how the missing information can be given to the district by telephone and/or email must be included in the letter sent requesting the information.
The DOH FAQ 5/20/20, states, "If you don´t provide the missing information your application may be denied." (FAQ #3).
MSP/Medicare Insurance Payment Program/ Health Insurance Premium Payment program - “the department can assist districts, if needed, with an extension of MIPP (Medicare reimbursements) and HIPP (health insurance reimbursements) payments to coincide with the extension of an individual’s authorization period.”
DOH guidance to Medicaid providers here and to all health care providers at this ink. See below for some key provider directives from DOH.
Key Medicaid home care guidance relevant for consumers:
TELEHEALTH - February 2023 Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency Special Edition 3/14/2023 Updated 5/8/2023 (Web), (Interactive PDF) or (Print-Ready PDF).
23-01: NYSDOH Guidance for use of Face Masks and Face Coverings in Healthcare Facilities (2-10-2023)
22-13: COVID-19 Screening of Home Care and Hospice Personnel
9/7/2022 - Commissioner's Determination on Masking in Certain Outdoor Settings
VACCINE MANDATE - On Jan. 25, 2022, DOH updated FAQ's about the emergency regulation passed on Aug. 26, 2021 mandating COVID-19 vaccinations for licensed home services agencies (LHCSAs) and certified home care agencies (CHHAs), among other providers. Workers at those agencies must have their first shots by Oct. 7. The FAQ No. 3 states that this mandate does not apply to CDPAP personal assistants. This expands the vaccination mandate announced on August 16th requiring all staff of nursing homes, other congregate care setings, and hospitals to have first shots by Sept. 27th. The DOH FAQ's exempted CDPAP PA's but in NYC it is possible that they are required to be vaccinated under a Dec. 2021 NYC Executive Order. The exact meaning of this order for CDPAP is unclear. The Gothamist reported on Oct. 16, 2021 the strain this has caused to some home care consumers, including a featured client of NYLAG who depends on round-the-clock private duty nursing.
Feb. 8, 2022 - DOH Amends the July 26, 2021 guidance Rescission of COVID-19 Guidance for the Authorization of Community Based Long Term Services and Supports Covered by Medicaid (previouly updated 9/30/21 and Jan. 5, 2022. As of Feb. 8, 2022 the rules are:
For Medicaid Managed care and MLTC plans, local Medicaid agencies, CDPAP agencies
7/26/21 - Instructions for Provider Personnel at Risk of COVID - providers should have policy to screen personnel for COVID symptoms/risk prior to home or in-person visits with consumers, and to send person home/ prevent in-home visit if sick.
UAS Nurse Assessments in Facilities (Nursing Homes) (does not mention Hospitals) --7/26/21 Guidance remains the same in 9/30/21 amendment, saying "where possible" in-person assessments must resume, but with masks and social distancing as required by facility. This would include conflict-free assessments by NY Medicaid Choice or Immediate Need assessments by the local Medicaid office/CASA and enrollment visits or other assessments by MLTC plans.
CDPAP personal assistants annual health reassessment - had been suspended but 9/30/21 guidance REQUIRES them to be done by 12/30/21 (extending time from 9/30/21 as DOH had stated in the 7/26/21 guidance)
Periodic re-assessments by nurses for managed care, MLTC and local Medicaid offices and 6-month care management visits for MLTC- these had been suspended, but the 7/26/21 Guidance required them to resume IN-PERSON. The 9/30/21 amended guidance says they can also be conducted by telehealth but not by phone.. Gives a phased in schedule for plans and LDSS to complete reassessments for those who were not assessed during the pandemic.
"Community Health Assessments" - a/k/a UAS Nurse Assessments - 9/30/21 guidance reinstates rule allowing UAS nurse assessment to be completed by telehealth, but still may not be conducted by telephone. Gives plans 90 days to complete an in-person OR teleheath UAS for anyone who had a "temporary" plan of care based on a partially completed UAS.
PHYSICIAN ORDERS - After 7/26/21, still allows physician to complete M11q/Physician's order by telehealth or telephone, without an in-person visit. However, physician may NO LONGER phone in order to initiate services, which before had allowed MD to follow up with written orders within 120 days.
Annual health assessment for all personnel - were originally suspended by an April 10, 2020 Dear Administrtor Letter but on October 14, 2020, the state issued a new Dear Administrator Letter lifting its suspension and requiring annual health assessment by December 31, 2020.
April 10, 2020 NYS DOH Dear Administrator Letter (see here) to CHHAs, LHCSAs, LTHHCPs, and Hospice programs, the state Department of Health has suspended or changed the following regulations.
The annual health assessment has been temporarily suspended for all employees. These assessments were reinstated again with Oct. 14, 2020 directive.
New employees may have health assessments completed by telehealth or by an RN. New employees must follow guidelines in place for all staff, including daily symptom screenings and at least daily temperature checks.
All CHHAs, LTHHCPs, AIDS home care programs and LHCSAs serving individuals affected by the COVID-19 public health emergency may conduct in-home and in-person supervision through indirect means, including by telephone or video communication, as soon as is practicable after the initial visit.
May 18, 2020 -NYLAG Know Your Rights Fact Sheet for MLTC Members about April 23, 2020 DOH Guidance on Voluntary Service Plan Changes -covers
ADVOCACY:
Letter to DOH 3/13/20 supplemented 3/16/20 - from NYLAG, Legal Aid Society, Empire Justice Center and other organizations
Letter to DOH 4/1/20 requesting protections for MLTC members and other long term care recipients from NYLAG, Empire Justice Center & Bronx Legal Services
“Emergency Services Only” Coverage - Medicaid Update Number 7: March 2020 Special Edition -
COVID-19 Coverage and Reimbursement Policy (published: 3/27/2020) (Web) or (PDF) — (Redline PDF).
NYS Medicaid coverage for undocumented immigrants is limited to emergency services only. COVID19 lab testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals with coverage code “07.” Claims submitted for COVID-19 tests and practitioner office visits for the purpose of COVID-19 testing, evaluation, and/or treatment should be identified as an emergency by reporting Emergency Indicator = Y.
Institutional providers (emergency department, hospital outpatient/diagnostic and treatment center, FQHC, and hospital inpatient) should report Type of Admission Code = 1 to indicate an emergency when the purpose of the visit is for testing, evaluation, and/or treatment related to COVID-19.
There is no copay for emergency services including testing, evaluation, and treatment for COVID-19.
These are recent guidance documents - see more at:
GUIDANCE FOR MEDICAID PROVIDERS - https://health.ny.gov/health_care/medicaid/covid19/index.htm
See ARCHIVES on COVID-19 and Medicaid in NYS for older directives
VACCINE MANDATE - May 24, 2023 -NYS Department of Health Statement on Repealing the COVID-19 Healthcare Worker Vaccine Requirement
“Due to the changing landscape of the COVID-19 pandemic and evolving vaccine recommendations, the New York State Department of Health has begun the process of repealing the COVID-19 vaccine requirement for workers at regulated health care facilities. Throughout the public health emergency, this vaccine requirement served as a critical public health tool, helping to protect both health care workers and the patients under their care. As the repeal of this regulation awaits consideration for approval by the Public Health and Health Planning Council (PHHPC), the Department will no longer enforce the requirement. However, it should be noted that facilities should continue to implement their own internal policies regarding COVID-19 vaccination.”
Please find the DAL to health care providers here. This repeals the
TELEHEALTH - February 2023 Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency Special Edition 3/14/2023 Updated 5/8/2023 (Web), (Interactive PDF) or (Print-Ready PDF).
ADULT DAY CARE PROGRAMS - Medical Model and Social Model
Social Adult Day Care programs in New York City may resume indoor activities beginning June 14, 2021. This is under NYC Emergency Executive Order of June 1, 2021. See the NYSADSA Reopening Guidance and other informtion posted here.
See COVID-19 archives for past Adult Day care guidance in 2020-21
Nursing Homes and Adult Care Facilities - Assisted Living
Vaccination Rates and COVID cases and deaths in Nursing Homes -
CMS is posting in two places -- comprehensive data re deaths and vaccine rates here. At that link, scroll down to this heading - Resources for Using and Understanding the Data - then click on the link in this paragraph: Listing of vaccination rates for individual nursing homes. If you download the Excel document, sort it by STATE then by COUNTY to find local nursing homes.
Also in CMS Nursing Home Compare database
March 2023 - Update: NYS Nursing Home Visitor Testing and Screening for COVID-19 -- nursing homes are no longer required to verify that visitors have a negative COVID-19 test before entry or conduct active COVID-19 screening. Guidance says aligned with CMS visitation guidance, which was further updated in May 2023 --
May 8, 2023 - CMS Updated Guidance on Nursing Home Visitation with FAQ, updated to align with the end of the Public Health Emergency May 11, 2023
"Facilities shall not restrict visitation without a reasonable clinical or safety cause, consistent with 42 CFR § 483.10(f)(4)(v). ... there are no longer scenarios related to COVID-19 where visitation should be limited, except for certain situations when the visit is limited to being conducted in the resident's room. Therefore, a nursing home must facilitate in-person visitation consistent with the applicable CMS regulations, which can be done by applying the guidance stated above. Failure to facilitate visitation, without adequate reason related to clinical necessity or resident safety, would constitute a potential violation of 42 CFR § 483.10(f)(4), and the facility would be subject to citation and enforcement actions.
If a nursing home is not following the revised CMS/CDC guidance, file a complaint with the NYS health department, making clear any harm or suffering that is resulting from the resident’s isolation. This includes emotional distress and psycho-social harm, which the health department is required to take seriously. Seek help from your local Long Term Care Ombudsman office.
This article written by Evelyn Frank Legal Resources Program, NYLAG eflrp@nylag.org Check back for updates