Service Authorization, Appeals, and Notices
For Medicaid Managed Long Term Care (MLTC) Plans
Medicaid Advantage Plus (MAP) Unified Appeals and Grievance
Medicaid Advantage Plus (MAP) plans are required to submit templates for certain notices to the Department at mltc.docs@health.ny.gov for approval prior to use.
- Templates will only be accepted from the health plan and must include the plan's unique identifier on each page.
- A completed and signed coversheet must accompany each template submitted.
- Member Materials Cover Sheet (PDF) - 11.14.2025
Centers for Medicare & Medicaid Services (CMS) Notices:
The CMS notices are posted under New York (Medicaid Advantage Plus (MAP) Model)
Department Medicaid Notices:
Model Notices
Model Notices for Medicaid Managed Long Term Care Plans (Partial and MAP)
Managed Long Term Care plans are required to submit templates for model notice types to the Department for approval prior to use. Templates will only be accepted from the health plan and must include the plan's unique identifier on each page. A completed and signed cover sheet must accompany each template submitted. Submit templates and cover sheets to: mltc.docs@health.ny.gov
- Complaint Appeal Resolution Notice (PDF)
- Complaint Resolution Notice (PDF)
- Extension Notice (PDF)
- Final Adverse Determination
- Initial Adverse Determination
- Approval Notice (PDF)
- Member Materials Cover Sheet (PDF) - 11.14.2025
MLTC Templates
- Involuntary Disenrollment - Intent to Disenroll Notice (PDF) - 4.7.2026
- Language Assistance Notice (PDF) - 3.28.2025
- Language Assistance Taglines (PDF) - 3.28.2025
- Notice of Non-Discrimination
- Member Materials Cover Sheet (PDF) - 11.14.2025
- Nursing Home Enrollee Intent to Disenroll Notice
- Electronic Notice (PDF)
Guidance for Health Plans
- Reasonable Effort Policy
- Guidance for Required Changes to Medicaid Model Notices About Service Authorization and Appeals under 42 CFR 438
- 2016 Final Rule FAQs About Service Authorization and Appeals under 42 CFR 438
- NYS MLTC Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations
- Best Practices for Written Notice to Enrollees Regarding the Provision of Aid Continuing Pending a Fair Hearing Decision
- NYS MLTC Service Authorization and Appeals Timeframe Comparison
- NYS MLTC Grievances Timeframe Chart
- NYS Department of Health Instructions for Medicare Advantage D-SNP Marketing and Communications
- Medicaid Advantage Plus (MAP) Integrated Appeals and Grievances Demonstration Phase-Out Plan
- Guidance for Applicable Integrated Plans on State Written Notice Requirements
Webinars
Medicaid Advantage Plus (MAP) Appeals and Grievance Demonstration *** No longer in effect ***
Beginning January 1, 2020, the Medicaid Advantage Plus (MAP) Appeals and Grievance Demonstration required that MAP plans certain notices when responding to Appeals and Grievances for their MAP plan. The use period for these notices was for dates of service between January 1, 2020 through December 31, 2025.
Important:The MAP Unified Appeals and Grievances notices must be used for dates of service beginning January 1, 2026. See the Medicaid Advantage Plus (MAP) Unified Appeals and Grievance section above.
- Appeal Decision (PDF) - 10.7.2024
- Appeal Decision Delay (PDF) - 1.2.2024
- Appeal Dismissal (PDF) - 12.2021
- Coverage Determination (PDF) - 10.7.2024
- Fast Complaint Letter(PDF) - 1.2.2024
Contact mltc.docs@health.ny.gov for any questions on this page.
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