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NYLAG Webinar CLE Announcement on "Exhaustion" - New Managed Care Appeal System - April 18, 2018 Download
Exhaustion Webinar - CLE Registration Form.pdf
Changes in federal Medicaid regulations will take effect in New York State May 1, 2018. These changes affect over 4.7 million New Yorkers -- all members of Medicaid Managed Long Term Care (MLTC) Plans and “mainstream” Medicaid managed care plans. If the managed care or MLTC plan denies or reduces a service after May 1, 2018, the member will be required to request an internal “Plan Appeal” first, and wait for the plan’s decision, before they request a Fair Hearing with the NYS Office of Temporary & Disability Assistance. In other words, they are required to “exhaust” the internal plan appeal before requesting a fair hearing. See more info about the new rule here -- http://www.wnylc.com/health/entry/184/.

The CLE will explain the new rule and its limited exceptions, and the new appeal process. It will also cover the new requirements for the plan member to “authorize” a representative to request a plan appeal or a fair hearing.

WHO: The CLE is sponsored for lawyer, paralegals, and other professionals working or volunteering in the non-profit sector, including social workers who assist seniors and people with disabilities in accessing Medicaid services.

CLE: The New York Legal Assistance Group has been certified as an Accredited Provider of Continuing Legal Education. 1.5 Professional Practice credits and .5 Skills credits have been authorized for this session. This course is appropriate for both newly admitted and experienced attorneys. CLE credit will not be available for future viewing of the recorded webinar.

COST: Free for those working in or doing pro bono work for a non-profit legal services, advocacy, or social services organization. Private lawyers and geriatric care managers are asked for a suggested donation of $75 per session
27 Mar, 2018 260 kb Downloads: 2819
NYLAG Testimony on NYS FY 2018-19 Budget - Joint Hearing of the Senate Finance and Assembly Ways and Means Committees Download
NYLAG Health statement JOINT HEARING 2-7-18 FINAL.pdf
NYLAG Testimony on NYS FY 2018-19 Budget - Joint Hearing of the Senate Finance and Assembly Ways and Means Committees - discusses spousal refusal and spousal impoverishment proposals, Managed long term care changes, and other proposals in NYS proposed budget.
09 Feb, 2018 541 kb Downloads: 2832
NYS DOH Model Managed Care/MLTC PLAN APPEAL DECISION Reducing Services - Effective March 1, 2018 Download
Final FAD With AC 11-20-17.pdf
The "Final Adverse Determination" template that NYS DOH has provided to Medicaid managed care and MLTC plans for Plan Internal Appeal Decisions affirming a proposed reduction of services. This notice must be used after March 1, 2018, when embers must first request an internal appeal and wait until that is decided before they may request a fair hearing. See more here http://www.wnylc.com/health/news/80/. This "Final Adverse Determination" will advise the member of the right to request a fair hearing with aid continuing.
26 Dec, 2017 679 kb Downloads: 3789
NYS DOH Model Managed Care/MLTC Notice Reducing Services - Effective March 1, 2018 Download
Final IAD With AC 11-20-17.pdf
The notice template that NYS DOH has provided to Medicaid managed care and MLTC plans for reducing services after March 1, 2018, on which date members must first request an internal appeal and wait until that is decided before they may request a fair hearing. See more here http://www.wnylc.com/health/news/80/. A sample of a completed notice is posted at http://www.wnylc.com/health/download/644/ - this is an unofficial sample using hypothetical facts, created by NYLAG for illustration.
22 Dec, 2017 738 kb Downloads: 3763
Sample of Model Notice of Reduction for Managed Care/MLTC Plans Reducing Services - After 3/1/18 Download
Final IAD With AC 11-20-17 Reduction Sample UNOFFICIAL (NYLAG).pdf
This is an unofficial sample of the model notice template that NYS DOH has given to Managed care and MLTC plans, to use after March 1, 2018. This is the notice for reducing services such as personal care. This sample was created by NYLAG on hypothetical facts. It is not an official sample. The official template is posted at http://www.wnylc.com/health/download/643/.
22 Dec, 2017 691 kb Downloads: 3812
State DOH Letter to Former Guildnet Members in LI, estchester 9-29-17 - May ask to Restore Hours Download
2017.10.16 DOH letter Guildnet redacted updated.pdf
Letter from State DOH to people who were in Guildnet MLTC plan in Nassau, Suffolk and Westchester counties and moved to another plan after Mar. 20, 2017. They must call NY Medicaid Choice before Dec. 29, 2017 to ask for their hours to be restored to the amount Guildnet had authorized, if the new plan reduced their hours.
16 Oct, 2017 81 kb Downloads: 3387
HRA CDPAP FI List - 6.2017 Download
2017-06-07 HRA CDPAP FI list.pdf
10 Oct, 2017 562 kb Downloads: 7225
Letter from North Shore LIJ MLTC Plan to members, dated 9/22/17, that plan closing 12/31/17 Download
North Shore LIJ - Letter to members closing redacted.pdf
Letter from North Shore LIJ MLTC Plan to members, dated 9/22/17, that plan closing 12/31/17. Informs member that unless chooses and enrolls in a different plan before 11/10/17, will be auto-assigned to Centers Plan for Health Living effective 1/1/18.
09 Oct, 2017 2.04 mb Downloads: 4595
NYC HRA Medicaid Alert 2017-07-26 Power of Attorney and Statutory Gift Rider Download
2017-07-26 Power of Attorney and Statutory Gifts Rider.pdf
"...[T]he New York Statutory Short Form Power of Attorney (NYSPOA), if executed after Sept. 1, 2009, may only be used to establish a trust, if section (h) of the NYSPOA is initialed and if a Statutory Gifts Rider (SGR) is also signed and witnessed by two persons, who are not named in the SGR as permissible recipients of gifts, at the same time as the referencing NYSPOA."
16 Aug, 2017 74 kb Downloads: 6316
Chart of Enrollment in MLTC Plans - Nassau, Suffolk, Westchester - March 2017 Download
Guildnet market share 11-2016 and 4-2017.pdf
Chart shows impact of withdrawal of Guildnet from Nassau, Suffolk and Westchester Counties per letters sent to 4000+ members in March 2017. See http://www.wnylc.com/health/download/621/
23 May, 2017 263 kb Downloads: 2890
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