Service Authorization, Appeals, and Notices

For Medicaid Managed Long Term Care (MLTC) Plans

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.

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 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

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.

Contact mltc.docs@health.ny.gov for any questions on this page.