15 May, 2020
As Social Distancing and shuttered offices become the new normal, New Yorkers who depend on Medicaid or need to apply for it need to learn new policies and procedures that are quickly being developed by the federal government (CMS), the NYS Department of Health (DOH), and by each local Medicaid agency, which in New York City is HRA. On this page we will gather links to helpful resources and to key government guidance, as well as describe advocacy done by NYLAG, Legal Aid Society, Empire Justice Center, Bronx Legal Services, and other organizations regarding Medicaid.
NEW - May 18, 2020 -NYLAG Know Your Rights Fact Sheet for MLTC Members about April 23, 2020 DOH Guidance on Voluntary Service Plan Changes in MLTC, FFS Home Care -
- What are members' rights to "pause" home care during the emergency?
- What are member's rights if plan tells member hours must be reduced because of Covid-19?
New - May 15, 2020 - NYS Dept. of Health updates Deaths in Nursing Homes from COVID - by NH
NYLAG consumer-friendly guide to many Covid-19 changes in benefits https://www.nylag.org/covid19/
Information on Housing, benefits, employment & unemployment, courts, taxes, powers of attorney, and many other benefits. For HEALTH, click on Medicaid (Applying), Medicaid (Home Care), Medicaid (If you Already Have), or Medicare.
In This Article:
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NYS OTDA Fair Hearing Information
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Medicaid Home Care - NYS Dept. of Health Policies and Procedures & Consumer Advocacy
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Medicaid Applications, Renewals, Eligibility in NYS - and Consumer Advocacy
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Emergency Medicaid for Undocumented Immigrants - Covers Covid-19 Testing & Treatment
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How do Covid-19 Federal Stimulus Payments impact SSI, Medicaid & other Benefits?
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Federal Authorities Allowing States flexibility in Disasters + NYS Request for 1135 Waiver
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NYS Dept. of Health Guidance for Health Care Providers
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Compilations of Resources from National & NYS Organizations
DOH is issuing frequent guidance to Medicaid providers here and to all health care providers at this ink.
See below for some key provider directives from DOH.
Here is some of the key home care guidance relevant for consumer Medicaid advocates:
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April 8, 2020 updating Mar. 18, 2020 - COVID-19 Guidance for the Authorization of Community Based Long-Term Services and Supports Covered by Medicaid – UPDATED 4.8.20
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For Medicaid Managed care and MLTC plans, local Medicaid agencies, CDPAP agencies
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Allows physician to complete M11q/Physician's order by telehealth or telephone, without an in-person visit. 4/8/20 update allows MD to CALL in order and follow up with written orders within 120 days. Plan or DSS can authorize 90-day temporary service plan based on oral orders
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Allows the UAS nurse assessment to be completed by telehealth or telephone (by MLTC plans and local Medicaid agencies), except that the conflict-free assessment by NY Medicaid Choice must be completed in person (at least for the functional assessment). If NY Medicaid Choice cannot do the assessment in person, "the member’s LDSS (local Medicaid office) will develop and monitor the plan of care." Unclear what that means.
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Suspends requirement for 6-month periodic re-assessments by nurses for managed care, MLTC and local Medicaid offices. 4/8/20 update also suspends requirement for M11q/physician's order for reassessments for personal care and CDPAP - however, services will only be reauthorized for 3 months, which will create burdens down the road..
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CDPAP personal assistants do not have to obtain the annual health reassessment, but new personal assistants must still have them (TB test, immunizations)
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UAS Nurse Assessments in Nursing Homes- it's up to the nursing home to decide whether the assessment is "medically necessary," so nursing home is apparently allowed to refuse access. This would be conflict-free assessments by NY Medicaid Choice or Immediate Need assessments by the local Medicaid office/CASA.
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April 10, 2020 NYS DOH Dear Administrator Letter (see here) to CHHAs, LHCSAs, LTHHCPs, and Hospice programs, the state Department of Health has suspended or changed the following regulations.
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The annual health assessment has been temporarily suspended for all employees.
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New employees may have health assessments completed by telehealth or by an RN. New employees must follow guidelines in place for all staff, including daily symptom screenings and at least daily temperature checks.
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All CHHAs, LTHHCPs, AIDS home care programs and LHCSAs serving individuals affected by the COVID-19 public health emergency may conduct in-home and in-person supervision through indirect means, including by telephone or video communication, as soon as is practicable after the initial visit.
- April 23, 2020 COVID-19 Guidance for Voluntary Plan of Care Schedule Change - (Web) (PDF) -
- Allows voluntary changes in service plans, presumably mostly reductions in hours of home care, on a temporary basis because of the pandemic. Plan must confirm the change in writing and have the consumer sign agreement. Plan must reinstate original service plan on 72 hours request. Advocacy concern exists allowing plan to reach out to consumers to ask for consent to a voluntary change-- this outreach is supposed to be limited to those consumers who have "refused or cancelled services because of concerns about COVID-19 exposure," or who are known to have available informal caregivers, but will consumers be pressured to agree to temporary reductions? See FACT SHEET for CONSUMERS - KNOW YOUR RIGHTS!
- This guidance does not expressly prohibit but should prevent plans from disenrolling members who have refused or cancelled services because of COVID.
ADVOCACY:
Under Families First Coronavirus Response Act signed on March 18, 2020, no Medicaid recipient will lose their coverage after March 18, 2020 through the end of the COVID-19 pandemic. The National Health Law Program fact sheet, available here, summarizing the Medicaid-related provisions that were included in the coronavirus response laws that Congress has passed in the last few weeks.
New York City Directives
If Medicaid was authorized for a period ending March 31, 2020 or later, the local district must recertify Medicaid for 12 months, regardless of whether the recipient fails to return renewals or respond to requests for information - Medicaid will NOT BE DISCONTINUED. DOH explains this will allow districts to devote the reduced staff to new applications rather than routine renewals.
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Under GIS 20 MA/04, "Medicaid cases are being extended and individuals will not be required
to renew their Medicaid eligibility during the emergency period. All active Medicaid cases with
authorization and coverage dates ending in March, April, May and June will be systemically
extended for 12 months." If a case was closed after March 18, 2020 it will be reopened.
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Those who lose SSI or public assistance, who would normally need to recertify for Medicaid under the Stenson and Rosenberg processes, will have Medicaid automatically extended for 12 months.
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Those who had MAGI Medicaid and turn 65, whose Medicaid would normally be transferred from NYSofHealth to the local district, to be redetermined under non-MAGI Medicaid rules - will have Medicaid automatically extended for 12 months. Since March 19th, these cases stopped being referred from NYSofHealth to the local district - coverage was just extended. They will not have to show that they applied for Medicare, or applied for VA benefits if they are veterans, contrary to the usual rule. Some cases may still be referred manually to the LDSS, such as those who need nursing home care, since institutional Medicaid can only be authorized by the LDSS even if eligibility is based on MAGI.
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"Individuals in the Medicaid Buy-In Program for Working People with Disabilities who have
experienced job loss as a result of the COVID-19 emergency must be given a grace period
due to loss of work. If applicable, the grace period should be extended for six (6) additional
months." GIS 20 MA/04
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Medicaid may not be discontinued for "whereabouts unknown" if correspondence from the LDSS/HRA is returned. GIS 20 MA/04 p. 3
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If had active Medicaid because of "Aid Continuing" on March 18, 2020, this must continue GIS 20 MA/04 p. 6. COMMENT: This seems be be required regardless of an adverse decision from the fair hearing.
Surplus/Spend-down Cases -- If the spend-down was met in March, the LDSS/HRA will put up coverage for 6 months. NYC Recipients who have problems submitting bills should follow the instructions on the HRA policy - and elsewhere contact their local district office. A spend-down may be reduced, but not increased, during the emergency (GIS 20 MA/04)
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Allows self-attestation of income, assets and most other factors of eligibility on applications, renewals and requests for increased coverage, except for documenting citizenship and immigrant status on applications.
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Citizenship and Immigration Status - GIS 20 MA/04 p. 3 - DSS/HRA will try to verify status through SSA data match. If that can't be done and documentation is needed, DSS/HRA will put up 90 days of coverage while applicant has an opportunity to obtain documentation. If the emergency period has not ended after 90 days, it will be extended for another 90 days if applicant still hasn't obtained documentation. See 10 OHIP ADM-8 for procedures "to give a reasonable opportunity period to consumers who are attesting to be U.S. Citizens."
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Individuals turning 65 do not have to apply for Medicare, SSA or VA benefits as a condition of eligibility
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Do not have to respond to reports received by local DSS after 3/1/20 -- that a Social Security number could not be verified, or that a resource appeared on an electronic match or could not be verified
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No proof of Third Party coverage is required - local districts are not required to make
new cost effective determinations for possible reimbursement if sufficient information
is not available. But if insurance ends, district may stop payment of premium. GIS 20 MA/04 p.6
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WHERE TO APPLY - Every local DSS has its own procedures.
MAKE CLEAR ON APPLICATION IF SEEKING TO ENROLL IN MLTC, or SEEKING MEDICAID ONLY.
Mail in Unit
MICSA
505 Clermont, 5th Floor
Brooklyn, NY 11238
- "Authorized Submitters" ("C-Reps') and providers who have been authorized by HRA to submit applications have been given dedicated fax lines - see
from GIS 20 MA/04 p.4- 5
... During this period, if an application or
Supplement A is missing required information, the district should contact the applicant,
authorized representative or the person submitting the application on behalf of the applicant,
if applicable, by email or telephone to obtain the necessary information. The district does not
need to receive the information in writing and can accept information verbally. The eligibility
staff should note in the case record any information obtained by phone and make a notation
in the case record that information was received verbally due to COVID-19 circumstances.
If after three (3) attempts, the local district is unable to contact the individual, the individual’s
authorized representative or the person who submitted the application on behalf of the
applicant (including when no response is received from an email contact), the local district
must send a written request to the individual and the authorized representative or person
submitting the application on behalf of the applicant, for the missing information. The request
sent must include a response due date of no less than 10 days. Information concerning how
the missing information can be given to the district by telephone and/or email must be
included in the letter sent requesting the information.
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MSP/Medicare Insurance Payment Program/ Health Insurance Premium Payment program - “the department can assist districts, if needed, with an extension of MIPP (Medicare reimbursements) and HIPP (health insurance reimbursements) payments to coincide with the extension of an individual’s authorization period.”
“Emergency Services Only” Coverage - Medicaid Update Number 7: March 2020 Special Edition -
COVID-19 Coverage and Reimbursement Policy (published: 3/27/2020) (Web) or (PDF) — (Redline PDF).
NYS Medicaid coverage for undocumented immigrants is limited to emergency services only. COVID19 lab testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals with coverage code “07.” Claims submitted for COVID-19 tests and practitioner office visits for the purpose of COVID-19 testing, evaluation, and/or treatment should be identified as an emergency by reporting Emergency Indicator = Y.
Institutional providers (emergency department, hospital outpatient/diagnostic and treatment center, FQHC, and hospital inpatient) should report Type of Admission Code = 1 to indicate an emergency when the purpose of the visit is for testing, evaluation, and/or treatment related to COVID-19.
There is no copay for emergency services including testing, evaluation, and treatment for COVID-19.
Clarifies that the one-time Stimulus payments and the $600 weekly Pandemic Unemployment compensation are not countable income for Medicaid, including under post-eligibility budgeting used in nursing home Medicaid, meaning that the payments will not be counted toward the NAMI (Net Available Monthly Income).
CARES ACT: ...Notwithstanding any other provision of law, any refund (or advance payment with respect to a refundable credit) made to any individual under this title shall not be taken into account as income, and shall not be taken into account as resources for a period of 12 months from receipt, for purposes of determining the eligibility of such individual (or any other individual) for benefits or assistance (or the amount or extent of benefits or assistance) under any Federal program or under any State or local program financed in whole or in part with Federal funds.
Click on https://www.nylag.org/covid19/ and go to Economic Stimulus Payments
These are just a few of the many guidance documents issued nearly every day - check
GUIDANCE FOR MEDICAID PROVIDERS - https://health.ny.gov/health_care/medicaid/covid19/index.htm
GUIDANCE FOR ALL HEALTH CARE https://coronavirus.health.ny.gov/information-healthcare-providers
TELEHEALTH -NYSDOH has issued a “broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely.”
- Medicaid Update Special Edition: Comprehensive Telehealth Guidance (Web) or (PDF) (published: 5/1/2020).
- Frequently Asked Questions (FAQs) on Medicaid Telehealth Guidance during the Coronavirus Disease 2019 (COVID-19) State of Emergency - (Web) - (PDF) - Updated 5.1.2020
- Webinar: New York State Medicaid Guidance Regarding Telehealth, Including Telephonic, Services During the COVID-19 Emergency - 5.5.2020
HOME CARE, WAIVER PROGRAMS, PRIVATE DUTY NURSING, DME
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Home Care Association of NYS - Covid-19 Resource Page
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April 10, 2020 NYS DOH Dear Administrator Letter (see here) to CHHAs, LHCSAs, LTHHCPs, and Hospice programs, the state Department of Health has suspended or changed the following regulations.
The annual health assessment has been temporarily suspended for all employees.
New employees may have health assessments completed by telehealth or by an RN. New employees must follow guidelines in place for all staff, including daily symptom screenings and at least daily temperature checks.
All CHHAs, LTHHCPs, AIDS home care programs and LHCSAs serving individuals affected by the COVID-19 public health emergency may conduct in-home and in-person supervision through indirect means, including by telephone or video communication, as soon as is practicable after the initial visit.
ADULT DAY CARE PROGRAMS - Medical Model and Social Model
Nursing Homes and Adult Care Facilities - Assisted Living
This article written by Evelyn Frank Legal Resources Program, NYLAG eflrp@nylag.org Check back for updates
