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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: 564
HSCP-3047b MLTC Nursing Home Eligibility Determination Cover Sheet Download
HCSP-3047b 1-26-2015.pdf
This is the cover sheet to used for MLTC NHED
13 Apr, 2015 55 kb Downloads: 1430
HCSP-3047a MLTC/PRU Download
HCSP-3047a MLTC-PRU 1-26-15.pdf
This is the MLTC Provider Relations Unit cover sheet to be used
13 Apr, 2015 47 kb Downloads: 553
HCSP 3026 ALP Medicaid Cover Sheet Download
HCSP-3026 HCSP Cover Sheet for ALP-MLTC 1-26-2015.pdf
This is the cover sheet for HRA-ALP Medicaid Cover Sheet
13 Apr, 2015 44 kb Downloads: 536
Notice of Admission/Discharge for the Assisted Living Program Download
HCSP 3027 1-26-2015.pdf
This form is to be mailed to Home Care Services Program once a client is admitted or discharged from Assisted Living Programs
13 Apr, 2015 44 kb Downloads: 686
MAP-259H Consumer Intent to Return/Not Return Home Download
MAP-259H Intent to Return Home 2008-06-20.pdf
This form is used when a client enters a residential facility and makes a determination that he/she will either return or not return home.
13 Apr, 2015 236 kb Downloads: 979
CASA Fact Sheet Download
CASA FAct Sheet 2015.doc
Fact sheet describing what is covered under Housekeeping Services and where CASA offices are located
09 Apr, 2015 30 kb Downloads: 1040
Fact Sheet on FIDA - by New York Legal Assistance Group Download
FIDA Fact Sheet NYC-Nassau (2015-4-1).pdf
Fact Sheet on FIDA with understanding of enrollment procedures as of Mar. 30, 2015. By NYLAG. Includes list of plans in Region 1 - NYC and Nassau. Revised to show enrollment postponed in Westchester and Suffolk
01 Apr, 2015 690 kb Downloads: 7561
FIDA 30-Day Notice - 30 Days Before Passive Enrollment - Final Reminder notice Download
M6 - 30-day PE Reminder Notice -11.29.14.docx
The NYS Dept. of Health's notice sent by its contractor, NY Medicaid Choice (Maximus) 30-days prior to "passive enrollment" into a FIDA plan. This notice follows an "announcement" notice (https://www.health.ny.gov/health_care/medicaid/redesign/docs/fida_prog_announce_brooklyn.pdf) a 90-day and 60-day notice. Both the 60-day and 30-day notices tell you which FIDA plan you will be assigned to if you do not OPT OUT.
25 Mar, 2015 37 kb Downloads: 1269
FIDA 60-Day Notice - 60 Days Before Passive Enrollment Download
M5 60-day PE Notice 11.29.14.docx
The NYS Dept. of Health's notice sent by its contractor, NY Medicaid Choice (Maximus) 60-days prior to "passive enrollment" into a FIDA plan. This notice follows an "announcement" notice (https://www.health.ny.gov/health_care/medicaid/redesign/docs/fida_prog_announce_brooklyn.pdf) and a 90-day notice, and is followed by a 30-day notice. Both the 60-day and 30-day notices tell you which FIDA plan you will be assigned to if you do not OPT OUT.
25 Mar, 2015 41 kb Downloads: 2822
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