DOH: Electronic Noticing Guidelines for Medicaid Managed Care Plans, Effective October 1, 2022

The Department of Health (DOH) has implemented the Guidance for Medicaid Managed Care Plans on Enrollee Electronic Notification of Managed Care Organization Determinations, effective October 1, 2022. This guidance applies to Medicaid Managed Care Plans (MMCP), including Mainstream Medicaid Managed Care (MMC) Plans, HIV Special Needs Plans (HIV SNP), Health and Recovery Plans (HARP), Managed Long Term Care Partial Capitation Plans (MLTCP), Program of All Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus Plans (MAP).

This guidance was part of a set of proposals developed through the Medicaid Redesign Team II (MRT II Project 157).

This guidance implements the electronic transmittal of Managed Care Organization (MCO) notices inclusive of any and all notifications required for MCO coverage determination, complaint, grievance, service authorization, adverse determination, or appeal processes under PHL 4408-a, PHL Article 49, and 10 NYCRR Part 98, when the enrollee/designee has indicated their preference to receive these notices by electronic means.

Questions about this guidance pertaining to MMC, HIV SNP, and HARP should be referred to OMCmail@health.ny.gov. Questions about this guidance pertaining to MLTCP, PACE, and MAP should be referred to MLTCinfo@health.ny.gov.

The guidance, template letter, and updated FAQ document can be found on the MRT II website https://www.health.ny.gov/health_care/medicaid/redesign/mrt2/policy/index.htm under Medicaid Managed Care Plan Policies and MLTC Policies.

Thank you.

Medicaid Redesign Team (MRT) Updates
New York State Department of Health
Office of Health Insurance Programs
One Commerce Plaza
Albany, NY 12237
mrtupdates@health.ny.gov

NYSHFA/NYSCAL CONTACTS:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36