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New York Government
CMS Memo 10/28/16 re FIDA Plans Not Renewing Contracts for 2017 Download
NY_FIDA_Non-renewing_Contracts_closeout instructions.pdf
Describes procedures for how members in those 3 plans not renewing contracts will be transitioned to other FIDA plans or may choose Original Medicare and MLTC.
02 Nov, 2016 141 kb Downloads: 384
Attestation for Immediate Need PCS and CDPAS - 16 ADM 02 Attachment Download
16adm2att.pdf
04 Aug, 2016 299 kb Downloads: 857
Immediate Need for PCS and CDPAS 16 ADM 02 Download
16adm2.pdf
04 Aug, 2016 324 kb Downloads: 1423
2nd Notice of Passive Enrollment into HARP/Behavioral Health Organization - 8/2015 Download
HP_ENG_HARP_Passive_Enrollment_Notice_From_Sister_Plan_0615_REV_A_FinalDraft_063015.pdf
Second form letter sent by NY Medicaid Choice to managed care members identified as eligible for Behavioral Health services, based on past usage. This is the second notice sent to people whose managed care plan has a sister behavioral health organization or HARP, in which the member will be passively enrolled because they did not choose a different HARP after receiving the first "announcement" notice (posted at http://www.wnylc.com/health/download/586/).
In NYC notices were sent in fall 2015 for enrollment in Oct, Nov or Dec 2015. Services begin January 2016. Upstate counties later.
06 Nov, 2015 237 kb Downloads: 837
NYS Announcement Letter Passive Enrollment into HARP Sister Plan Download
HF_ENG_HARP_Announcement_A_Passive_With_Sister_Plan_Final_08_03_2015.pdf
Form letter sent from NYS DOH, OMH and OASAS to managed care members identified as eligible for Behavioral Health services, based on past usage. This is the "announcement" notice sent to people whose managed care plan has a sister behavioral health organization or HARP, in which the member will be passively enrolled unless they choose a different HARP.
In NYC notices were sent in fall 2015 for enrollment in OCt, Nov or Dec 2015. Services begin January 2016. Upstate counties later.
06 Nov, 2015 277 kb Downloads: 924
State DOH Templates for MLTC Denials, Reductions, Terminations - effective July 1, 2015 Download
New MLTC Notices of Adverse Action - June 2015.pdf
Combined in one PDF is March 2015 State directive to MLTC plans requiring use of new templates for notifying member of reductions, denials, and terminations of services. Templates should be used by mid-May 2015. PDF includes Directive plus TWO new notice templates and the state's EXAMPLES of how the two templates are used. Also included is a sample of notice that MLTC plans sent to all members in June 2015 notifying of elimination of requirement to "exhaust" internal appeals before requesting fair hearing
25 Jun, 2015 1.2 mb Downloads: 39143
Policy Change for the Start Date of the Transfer of Assets Look Back Period Download
2015-06-02 Policy Change for the Start Date of the Transfer of Assets Look Back Period.pdf
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.
02 Jun, 2015 308 kb Downloads: 1004
Newborn Processing Update Download
2015-05-06 Newborn Processing Update.pdf
Update advised that all newborns born in 2015 submitted via the NYS automated system have been determined processed either automatically or manually
06 May, 2015 191 kb Downloads: 1262
HIPAA Compliant Authorization Form 1-2013 Download
HIPAA Compliant Authorization Form 1-2013.pdf
HIPAA form
13 Apr, 2015 47 kb Downloads: 5218
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical & Medical Facilities Download
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical and Medical Facilities.pdf
This informational letter provides social services districts with updated charts that represent the monthly Personal Needs Allowance, PNAs, for residents of non-medical facilities the PNAs in medical facilities.
13 Apr, 2015 302 kb Downloads: 436
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