Service Authorization and Appeals
For Mainstream Medicaid Managed Care Plans, HARP, and HIV SNP
Webinars
Guidance for Health Plans
- Guidance for Required Changes to Final Adverse Determination Notices - (PDF)
- Reasonable Effort Policy - (Web) - (PDF) - 4.17.23
- Guidance for Required Changes to Medicaid Model Notices About Service Authorization and Appeals under 42 CFR 438 - (Web) - (PDF) - November 4, 2021
- 2016 Final Rule FAQs About Service Authorization and Appeals under 42 CFR 438 - (Web) - (PDF) - January
- Supplemental Final Rule FAQs - (Web) - (PDF) - revised February 7, 2018
- New York State Medicaid Managed Care Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations - (Web) - (PDF)
- New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Comparison -- (Web) - (PDF)
- New York State Medicaid Managed Care Grievances Timeframe Chart - (Web) - (PDF)
DOH Model Notices
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.
- Notice of Non-Discrimination - (Web) - (PDF)
- Template Notice Submission Cover Sheet - (Web) - (PDF) - 11.4.2021
- Complaint Appeal Resolution Notice - (Web) - (PDF) - 11.4.2024
- Complaint Resolution Notice - (Web) - (PDF) - 11.4.2024
- Extension Notice - (Web) - (PDF) - 11.4.2024
- Final Adverse Determination
- Initial Adverse Determination
- Approval Notice - (Web) - (PDF) - 11.4.2024
Contact bigaplans@health.ny.gov for any questions on this page.
