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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: 1248
MAPDR-05 (05/28/2015) List of Managed Care & Managed Long Term Care Plans in NYC Download
2015-05-28 MAP DR-05 Provider ID Numbers and Plan Codes.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Medicaid Advantage (for dual eligibles)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA)

Updated May 28, 2015
01 Jun, 2015 164 kb Downloads: 38216
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: 36715
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: 1451
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: 3390
MAP 649F Undercare Download
MAP 649F UnderCare Transmittal.pdf
Undercare Renewal/Follow-up Transmittal
13 Apr, 2015 79 kb Downloads: 699
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: 851
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: 906
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: 1853
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: 848
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