DOH Webinar on Service Authorization and Appeal Changes for Medicaid Managed Care
The Department of Health (DOH) will be implementing changes required by the Centers for Medicare and Medicaid Services (CMS) relating to Medicaid managed care service authorization, appeals, fair hearings, and grievances. DOH will be holding two free webinars for providers, enrollees, and community representatives on the changes on March 28th and 30th. These are significant changes and apply to New York's mainstream Medicaid managed care, Health and Recovery Plans (HARPs), HIV Special Needs Plans, MLTC Partial Capitation, Medicaid Advantage, and Medicaid Advantage Plus.
Starting May 1, 2018, plans will be required to complete review of service authorization requests under different timeframes, issue revised enrollee notices, and, for adverse determinations made on May 1, 2018 and thereafter, follow revised appeal processes. Among the several changes, two key provisions relate to a requirement to exhaust a plan's appeal process before proceeding with a State Fair Hearing and requiring enrollee payment for services provided during the appeal and fair hearing process if it is determined that services are ultimately denied.
To learn more and access the link to the webinars, please click here.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871