Medicaid Managed Care Policy Documents by Year

Updated Instructions for Completing the Notice of Denial of Medical Coverage (or Payment) CMS-10003-NDMCP for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program - (PDF)

Revised August 22, 2025: New Minimum Needs Requirements for Personal Care Services (PCS), Consumer Directed Personal Assistance Services (CDPAS) and Managed Long Term Care (MLTC) Eligibility - (PDF) - (Web) - 6.30.2025

Employment and Payment of Personal Assistants (PAs) through Pendency of Preliminary Injunction - 4.14.2025

Consumer Directed Personal Assistance Program (CDPAP) Statewide Fiscal Intermediary (SFI) On-Going Policy for Medicaid Managed Care (MMC) Plans - (PDF)

Social Care Network (SCN) Program Policy - 2.10.2025

Fair Hearing Series 3 Policy Update - 2.4.2025

Transition of School-Based Health Center Benefit & Population into MMC

  • For more information: Transition of Coverage from Medicaid Fee-for-Service to MMC

CDPAP SFI Transition Policy for MMC Plans.

For more information: CDPAS

Guidance for Required Changes to Final Adverse Determination Notices

Guidance for the Implementation of the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program Model Member Handbook Addendum

Instructions for Completing the Notice of Denial of Medical Coverage (or Payment) CMS-10003-NDMCP for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program

Reasonable Effort Policy (PDF)

Medicaid Managed Care Guidance and Application to Offer Cost-effective Alternative Services (In Lieu of) (PDF)

Updates to In Lieu of Services or Settings (ILS) Application Process and Guidance (PDF)

Clarification on Legal Guardians Serving as CDPAS Personal Assistants (PDF)

Home and Community Based Services Person-Centered Service Planning Guidelines for Medicaid Managed Care Organizations, Local Departments of Social Services, and Health Homes (PDF)

Cultural Competence Training for Participating Providers (PDF)

Cultural Competence Training Reminder Notice to Plans (PDF)

Process for Expedited Request for Assessment and the New York Independent Assessor (NYIA) (PDF)

ADDITIONAL REVISION - Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis (PDF)

Medicaid Perinatal Care Standards

Guidance for Medicaid Managed Care Plans on Enrollee Electronic Notification of Managed Care Organization Determinations

Cultural Competence Training for Participating Providers (PDF)

Guidance for Required Changes to Medicaid Model Notices About Service Authorization and Appeals Under 42 CFR 438

Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care

Prior Authorization Minimum Data Set Policy: Prior Authorization Minimum Data Set Policy

Coding and Reimbursement for Sepsis

NYS Department of Health Standard Clauses for Managed Care Provider/IPA/ACO Contracts with Indian Tribal Health Providers

Harm Reduction Services

Criteria Standards for the Authorization and Utilization Management of Harm Reduction Services

Criteria Standards for the Authorization and Utilization Management of Hormone Therapy and Surgery for the Treatment of Gender Dysphoria

Wage Parity Compliance and Certification Guidance (MLTC Policy 21.03)

Transition of Clotting Factor Products and Services from Medicaid Fee-for-Service to Medicaid Managed Care

  • For more information: MRT 8401: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Standard Clauses for Managed Care Provider/IPA/ACO Contracts

Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs

Guidance for Mainstream Medicaid Managed Care Plans for the Development and Submission of Telehealth Innovation Plans

NYS Medicaid Managed Care Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations

Transition of Nursing Home Benefit and Population into Managed Care

  • For more information: MRT 1458: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Guidelines for the Provision of Hospice Services in Mainstream Medicaid Managed Care

  • For more information: MRT 1458: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Guidelines for the Transition of Adult Day Health Care and AIDS Adult Day Health Care Services in Medicaid Managed Care

  • For more information: MRT 1458: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Policy and Proposed Changes to Transition Children in Direct Placement Foster Care into Medicaid Managed Care

  • For more information: MRT 1458: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Policy and Proposed Contract Changes to Transition Long Term Home Health Care Program Non-dually eligible participants into Medicaid Managed Care

  • For more information: MRT 1458: Care Management Population and Benefit Expansion, Access to Services, and Consumer Rights

Guidelines for Consumer Directed Personal Assistance Services

Orthodontia for Children with Severe Handicapping Malocclusion

Transition of Dental and Orthodontia

Policy and Guidance to Transition the Homeless Population into Medicaid Managed Care

Guidelines for the Provision of Personal Care Services in Medicaid Managed Care

Management Contract Guidelines for MCOs and IPAs: https://www.health.ny.gov/health_care/managed_care/pdf/mgmt_contract_guidelines.pdf

OMH Adult Behavioral Health Managed Care Policy, Guidance, and Resources

OMH Community Oriented Recovery and Empowerment (CORE) Overview Benefit and Billing Guidance

OMH Crisis Intervention

OMH Children's Health and Behavioral Health System Transformation

Additional Coverage and Reimbursement Documents from the Office of Addiction Services and Supports

Medicaid Updates are released monthly, and contain information on both Medicaid Fee-for-Service and Medicaid Managed Care Policy