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Home Care
Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (07-2020) Download
Physician's Order Nassau County Form 517 - (2020).pdf
Form for doctor to complete to request Medicaid personal care services and CDPAP from the Nassau County DSS. Revised July 2020.
26 Aug, 2021 1.46 mb Downloads: 10622
CASA Directory Updated 9-09-2020 (Home Care Services Program (HCSP) Download
2020-09 NYC Home Care Services Program -CASA directory.pdf
CASA field offices have been consolidated. There is one CASA office per borough. Includes announcement of new email address for HCSP inquiries
04 Aug, 2021 309 kb Downloads: 6585
Contact List of CASA Offices - Home Care Services Program (HCSP) Download
2020-09 NYC Home Care Services Program -CASA directory.pdf
Includes announcement of new e-mail address for inquiries about HCSP cases (7-2021)
04 Aug, 2021 309 kb Downloads: 34782
Know your Rights: Tips for Requesting New or Increased Services from a Medicaid Managed Care or MLTC Plan Download
Requesting Services from an MCO 2021.pdf
Fact Sheet prepared by the NYLAG Evelyn Frank Legal Resources Program explaining tips on how to request new or increased services from a Medicaid managed care or MLTC plan, including the timeline in which the plan must process the increase. Russian translation posted at http://www.wnylc.com/health/download/782/

If the request is denied, see separate Fact sheet on appealing denials. http://www.wnylc.com/health/download/654/.
03 Aug, 2021 360 kb Downloads: 3873
Know your Rights: Tips for Requesting New or Increased Services from a Medicaid Managed Care or MLTC Plan (RUSSIAN) Download
Requesting Services from an MCO - 2021 Russian Translation.pdf
Russian Translation of Fact Sheet prepared by the NYLAG Evelyn Frank Legal Resources Program explaining tips on how to request new or increased services from a Medicaid managed care or MLTC plan, including the timeline in which the plan must process the increase. English version is at http://www.wnylc.com/health/download/723/

If the request is denied, see separate Fact sheet on appealing denials. http://www.wnylc.com/health/download/654/
03 Aug, 2021 659 kb Downloads: 1210
2021-7-22 MAP New Home Care Services Program Inquiry Email Address Download
2021-07-22 HCSP inquiries by email.pdf
This Alert is to advise Medicaid Providers, Hospitals, Client Representatives, Community Based Organizations, Certified Home Health Agencies(CHHA), and Advocates, that the Home Care Services Program (HCSP) has created an email inbox to allow for the submission of inquiries related to HCSP Medicaid case transactions using hcspinquiries@hra.nyc.gov. Allowed inquiries/transaction include demographic changes, address updates, pooled trust review, county-to-county transfer requests, Medicare Savings Program and coverage updates. This email is NOT FOR SUBMITTING APPLICATIONS or documents related to an application. Please read Alert for required information.
26 Jul, 2021 129 kb Downloads: 1962
NYLAG Comments on How State Proposes to Implement the "Lookback" for Community -Based Long Term Care Services Download
NYLAG Comments to CMS 5-6-2021 1115 Waiver Lookback.pdf
Comments filed on May 5, 2021 in response to the State Dept. of Health's proposal to CMS on how it will implemenet the 30-month Lookback, that was enacted in the NYS FY 20-21 Budget, and applies to MLTC enrollment and all other home care and the Assisted Living Program. The State's proposal can be viewed at https://health.ny.gov/health_care/medicaid/redesign/mrt2/proposals/30-month_lookback-final.htm
16 May, 2021 820 kb Downloads: 1391
MAP-751K Consumer Request to Change Information on File (3-15-21)(fill-able) Download
MAP-751K (3-15-2021)(English)(fill-able).pdf
NYC HRA Form to use to notify HRA of change in name, address, mailing address, date of birth, SSN, and to request mail in different languages or formats for disability (Updated 3-15-21). The MAP-751K is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages. Upon completion, it can be faxed to HRA using 917-639-0837. (Updated 2-18-2021) NOTE: The 751k is no longer used to request a change in budgeting. For that, use new form MAP-751W posted at the same webpage as above for the 751K.
16 May, 2021 89 kb Downloads: 8859
"Coverage Determination Notice" - Official Template for NYS MAP Plans using Integrated Appeal process Download
ICDN_NY_MAP - Coverage Determination Notice 11.15.19.docx
Official template for NYS Medicaid Advantage Plus plans to deny an initial request for prior approval for a service or for an increase in a service. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.
01 Apr, 2021 64 kb Downloads: 1560
"Appeal Decision Notice" for NYS Medicaid Advantage Plus plans (MAP) Download
AppealDenial_NY_MAP FINAL 11.15.19.docx
State template for final decisions after the internal plan appeal in the new integrated appeal procedure that began in 2020 for MAP plans. See article at http://www.wnylc.com/health/entry/225/. This form is from a zipped file of MAP notice templates posted at https://www.cms.gov/files/zip/nyiagintegratedbenenotices.zip.
01 Apr, 2021 81 kb Downloads: 1588
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