• 42 CFR 438 MMC Service Authorization and Appeals - MMC/HIV SNP/HARP
  • Information for ALJs - April 20, 2018
  • Aid to Continue - April 13, 2018
  • Questions and Answers - December 15, 2017
  • Presentation - November 30, 2017

• Guidance for Required Changes to Final Adverse Determination Notices
• Reasonable Effort Policy - 4.17.23
• Guidance for Required Changes to Medicaid Model Notices About Service Authorization and Appeals under 42 CFR 438 - November 4, 2021
• Best Practices for Written Notice to Enrollees Regarding the Provision of Aid Continuing Pending a Fair Hearing Decision
• 2016 Final Rule FAQs About Service Authorization and Appeals under 42 CFR 438 - Updated October 2025
• Supplemental Final Rule FAQs - revised February 7, 2018
• New York State Medicaid Managed Care Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations
• Revised New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Comparison
• New York State Medicaid Managed Care Grievances Timeframe Chart
• Archive
  • New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Comparison

DOH Model Notices for Mainstream Medicaid Managed Care Plans, HARP, and HIV SNP

Medicaid managed care plans are required to submit templates for these notice types to the Department for approval prior to use. Templates will only be accepted from the health plan and must include a unique identifier on each page. A completed and signed cover sheet must accompany each template submitted. Submit templates and cover sheets to: bigaplans@health.ny.gov.

• Complaint Appeal Resolution Notice (PDF) - 7.25
• Complaint Resolution Notice (PDF) - 7.25
• Extension Notice (PDF) - 7.25
• Final Adverse Determination
  • Denial Notice (PDF) - 7.25
  • Notice to Reduce, Suspend or Stop Services (PDF) - 7.25
• Initial Adverse Determination
  • Denial Notice (PDF) - 7.25
  • Notice to Reduce, Suspend or Stop Services (PDF) - 7.25
• Approval Notice (PDF) - 7.25
• Language Assistance Notice (PDF)
• Language Assistance Taglines (PDF)
• Notice of Non-Discrimination
• Template Notice Submission Cover Sheet - 11.4.2021