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 - 6.30.2025

• Alzheimer's Disease or Dementia Form (DOH-5821) (PDF)
• DOH NYIAP Mainstream Managed Care Minimum Needs Webinar Slides (PDF)
• 2025-08-12 Minimum Needs Requirements for MMC, HIV SNPs, and HARPs (YouTube)

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)

• CDPAP Agreement
  • For more information: Consumer Directed Personal Assistance Services (CDPAS)

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

• For more information: Service Authorization and Appeals

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

• For more information: Information for Health Plans

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)

• For more information: Service Authorization and Appeals

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

• For more information: Information for Health Plans

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)

• For more information: Information for Health Plans

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)

• For more information: Information for Health Plans

Medicaid Perinatal Care Standards

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

• For more information: Policies & Guidance

Cultural Competence Training for Participating Providers (PDF)

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

• For more information: Service Authorization and Appeals

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

• For more information: 29-I Health Facility (VFCA transition)

Prior Authorization Minimum Data Set Policy: Prior Authorization Minimum Data Set Policy (PDF)

Coding and Reimbursement for Sepsis (PDF)

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

• For more information: Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs

Harm Reduction Services

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

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

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

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

• For more information: Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs

Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs (PDF)

• For more information: 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 (PDF)

• For more information: Information for Health Plans

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

• For more information: Service Authorization and Appeals

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 (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