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Home Care
Form M-11q - Medical Request for Home Care (12-9-014) Download
HCSP-M11q (12-9-2014)Fill-in-able.2.pdf
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.
21 May, 2015 137 kb Downloads: 36655
Statewide Contact list of MLTC-MAP-PACE plans by County Download
STATEWIDE LIST OF Managed Long Term Care 6 and 4-2015.pdf
Statewide Contact list of MLTC-MAP-PACE plans by County from http://www.health.ny.gov/health_care/managed_care/mltc/mltcplans.htm - updated with April. 2015 enrollment data
13 May, 2015 526 kb Downloads: 21812
NYLAG Evelyn Frank Program "Appendix" of documents on MLTC and FIDA for CLE 4/20/15 Download
Appendix Final.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.
27 Apr, 2015 2.24 mb Downloads: 16099
PowerPoint Presentation by NYLAG Evelyn Frank Program on FIDA and MLTC 4/23/2015 Download
2015 NYLAG CLE MLTC-FIDA updated 4-23-2015.pptx
PowerPoint Presentation by NYLAG Evelyn Frank Program on FIDA and MLTC 4/23/2015.
Updated version of presentation in live CLE conducted APril 20, 2015
27 Apr, 2015 1.89 mb Downloads: 2561
Presentación de Powerpoint Sobre FIDA y MLTC Download
Caregiver Presentation Spanish Final 4-13-15.pdf
Esta presentación fue realizada el 13 de Abril 2015 en una organización local en Brooklyn para los residentes de ese edificio. La presentación es en español. Esta presentación se enfoca en los temas de Medicare, Medicaid, planes de cuidado a largo plazo (MLTC), y planes de doble ventaja totalmente integrado (FIDA).

Debe de usar estos materiales con la grabación sobre FIDA.

This presentation took place on April 13th, 2015 for local Brooklyn residents residing in senior housing. The presentation was conducted in Spanish. The presentation discussed Medicare, Medicaid, Managed Long Term Care plans (MLTC), and Fully Integrated Dual Advantage plans (FIDA).

Please view the powerpoint in conjunction with the Spanish recording of the presentation.
27 Apr, 2015 355 kb Downloads: 1178
Consumer Coalition Proposed Revision - FIDA NOTICES 3-4 - 60-Dayand 30-Day Passive Enrollment Notice (5/30/14) Download
FIDA 60 day and 30 day Notices combined 04-20-2015.pdf
On May 22, 2014, DOH provided Consumer advocates with drafts of notices regarding passive enrollment in FIDA to begin fall 2014. This is the Consumer coalition's proposed revision of NOTICEs 3 and 4 (60-day and final 30-day notices before Passive Enrollment).
20 Apr, 2015 356 kb Downloads: 5180
Troubleshooting Problems Enrolling in MLTC Plans - Tips for Avoiding Delays and Medicaid Spend-down Problems Download
Troubleshooting - 4-16-15 pp.pdf
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)
16 Apr, 2015 2.11 mb Downloads: 14227
NY HRA HCSP MLTC Cover Sheet ("Conversion" Form) -- HCSP 3047a (1/26/2015) replaces HCSP-3022 (9/26/2013) Download
HCSP-3047a MLTC-PRU 1-26-15_150415121649.pdf
"Conversion" Form used in NYC by MLTC, PACE and Medicaid Advantage Plus plans to ask HRA Medicaid program to convert the Medicaid eligibility codes and allow them to enroll an individual who has been determined eligible for Medicaid into MLTC plan. Most commonly needed for people with a spend-down. They may have been found eligible for Medicaid but Medicaid is not activated until spend-down is met OR until HRA has processed this "conversion" to activate Medicaid even if spend-down is not met. Also see MLTC Frequently Asked Questions HCSP Quick Reference- REVISED 11-13-2013.pdf posted on this site
15 Apr, 2015 58 kb Downloads: 3383
HSCP-3046 Home Care Services Program Cover Sheet Download
HCSP-3046 1-26-2015.pdf
This is the cover sheet to be used for Home Care Services Program
13 Apr, 2015 38 kb Downloads: 846
HCSP 3047 MLTC Cover Sheet Download
HCSP 3047 1-26-2015.pdf
This is the cover sheet to be used for MLTC cases
13 Apr, 2015 44 kb Downloads: 892
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