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MLTC Hospice Guidance Sets Forth New Procedures to Prevent Duplicate Billing

MLTC Policy 23.02 notifies plans and providers of a new Recipient Restriction Code to identify Medicaid beneficiaries who have elected hospice and requires plans to obtain and incorporate the DOH Form 5778 into care plans in order to coordinate services and financial obligations with the hospice provider.

June 26, 2023


OMIG Releases Guidance on Compliance with New Regulations

The comprehensive guidance supports implementation of newly adopted regulations and covers compliance programs; self-disclosure; and Medicaid managed care fraud, waste, and abuse prevention programs.

February 6, 2023


OMIG Regulations Expand Compliance Program, Overpayment, and Managed Care Plan Requirements

OMIG has adopted new regulations expanding requirements governing compliance programs; strengthening Medicaid managed care plan fraud, waste, and abuse prevention programs; and codifying OMIG’s self-disclosure program for Medicaid overpayments.

January 24, 2023


DOH Is Accepting Comments on Statewide Transition Plan for Compliance with Federal HCBS Settings Rule

Comments are due by Jan. 6, 2023.

January 3, 2023


CMS Proposes Wide-Ranging Medicare Advantage Rule

Policy proposals for 2024 seek to streamline prior authorizations, limit certain marketing practices, and expand health equity provisions.

December 20, 2022


Roll-Back of Independent Assessment Process Sought by LeadingAge NY, Other Advocates

In a letter to DOH, the associations and consumer advocates requested suspension of independent clinical assessments and a delay in the launch of independent 'immediate need' and 'expedited' initial assessments and independent reassessments, in light of scheduling, customer service, and accuracy concerns.

November 1, 2022


Electronic Noticing Effective Oct. 1st

Medicaid managed care plans, including MLTCP, MAP, and PACE, are required to provide all notices electronically to members who indicate that preference.

October 11, 2022


DOH Webinar Reviews SADC Site Evaluation Tool

Tool and accompanying guide were developed by DOH to assist MLTC plans in verifying that network SADC sites are compliant with state and federal requirements.

September 20, 2022


LeadingAge NY Seeks Delay in Implementation and Added Flexibility in Comments on Proposed OMIG Regs

LeadingAge NY's comments also requested that PACE programs be exempt from managed care provisions of the proposed regulations.

September 12, 2022


CMS Unveils Tools to Improve State and Federal Oversight of Medicaid Managed Care Plans

The tools include an update on the web-based portal for state reports on managed care; two additional state reporting templates related to MLR and network adequacy and access assurances; a new technical assistance toolkit for states to oversee access in MLTC programs; and recommended practices for ensuring timely and accurate payment to Indian health care providers.

July 12, 2022
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