DOH Medicaid Update Aug 2003 Vol.18, No.8

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As mentioned in previous Medicaid Update articles, Computer Sciences Corporation (CSC), on behalf of the New York State Department of Health, has developed the Electronic Provider Assisted Claim Entry System (ePACES). ePACES is a web-based application that allows providers to request and receive HIPAA compliant claims (professional, institutional, and dental), eligibility, claim status inquiry, service authorization, and dispensing validation system transactions.

ePACES is replacing the current Medicaid Eligibility Field Software and the PACES applications. Providers must enroll to use the ePACES application, even if they currently use PACES or the Medicaid Eligibility Software.

Providers will be receiving the ePACES enrollment letter in the mail this summer, with instructions on how to enroll. When the ePACES enrollment process has been completed, the provider's System Administration account will be activated so the provider can start using the web-based ePACES application on September 27, 2003.

After September 27, 2003, the current PACES and Medicaid Eligibility Field Software applications will not be HIPAA compliant.

If you have any questions, please call the HIPAA Help Desk at (866) 840-3445.

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Time is running short. As reported in our past mailings and Medicaid Updates, due to the new HIPAA regulations, the VeriFone TRANZ 330 POS device will need to be replaced or you will be required to switch to an alternate access method to interface with the NYS Medicaid Systems.

Ordering Information
In June, we notified providers about submitting transactions via a POS device. We included instructions and a form for ordering a new device in our notification letter. If you are a POS user and have not received a letter, please call (800) 343-9000 (Option 4) for the Provider Services POS Inquiry Line. This line is available Monday through Friday between 9:00 AM and 5:00 PM. Providers with Internet access can also obtain this information at http://www.eMedNY.org under "What's New."

About the Omni 3750 (Pricing/Features)
The Omni 3750 has been priced at $817 (includes shipping and handling) plus tax and will include the following features:

• Five year warranty on hardware failures
• Expedited Replacement Service (overnight replacement of damaged units)
• Integrated printer
• Faster modem for improved transmission speeds
• Easier to use ATM keys

Please note! As an alternative to using the POS device, the Medicaid Eligibility Field software replacement program called ePACES will be available in September of this year. ePACES will be available to Providers at no cost. We notified providers in July about how to access this system, and an article in the July Medicaid Update also contains more information on ePACES.

You should order now to avoid any delays due to a potential last minute surge of orders prior to the October 16^th deadline. Keep in mind that your new Omni 3750 can be used to access eMedNY just like the TRANZ 330, until such time as you receive instructions to download the new HIPAA software. The HIPAA software needs to be installed and working prior to October 16^th or an interruption of service could result.

Please contact the Provider Services POS Inquiry Line at (800) 343-9000 (Option 4) if you have any questions.

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All Providers must mail signed Trading Partner Agreements (TPA), filed by their Provider number, to the NYSDOH to be activated to send and receive HIPAA transactions. Providers received hard copies of the TPA in the mail and should return signed copies as soon as possible to Computer Sciences Corporation, Attn. HIPAA TP EDI Coordinator, 800 North Pearl Street, Albany, NY 12204.

In addition, all Trading Partners, defined as the entity that transmits the ANSI X12 HIPAA data directly to NYSDOH, must have signed TPAs filed by Trading Partner ID with NYSDOH. These TPAs will be sent to Trading Partners via email, along with their Trading Partner ID, as Trading Partners register for Edifecs Open Testing at the DOH's website at: https://www.hipaadesk.com/?nymedicaid

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Optometrists who are appropriately certified by the State Education Department (SED) may bill the NYS Medicaid Program for office-based evaluation and management visits and consultations for the diagnosis and treatment of diseases of the eye.

The billing section of the MMIS Provider Manual for Ophthalmic Services instructs optometrists to leave blank the Diagnosis Code (24F) field (Page 3-43). Diagnosis coding, however, is required on the claim when billing for one of the office-based evaluation and management and/or consultation procedures listed below. Claims without a diagnosis code will deny.

Revised Billing Instructions for Completion of Field 24F-Diagnosis Code: Please insert this article in the Billing Section (Page 3-43) of the provider manual. Providers who submit claims electronically or via magnetic media should contact Computer Sciences Corporation at (800) 522-5518 or (518) 447-9860, for help with billing.

24F.     DIAGNOSIS CODE (Block Billing)

Leave this field blank, except when billing for office-based evaluation and management and consultation procedures listed on Pages 4-11 through 4-14 of this manual. Claims for these procedure codes require diagnosis coding.

Using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding system, enter the appropriate code which describes the main condition or symptom of the recipient for which the procedure was performed. The diagnosis code digits should be entered in the correct spaces in relation to the decimal point. Diagnosis codes with subcategories must be entered with the subcategories indicated after the decimal point. A 3-digit diagnosis code (no entry following the decimal point) will only be accepted when the diagnosis code has no subcategories. The following is an example of an ICD-9-CM diagnosis code properly entered in Field 24F:

 

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With implementation of Phase I of eMedNY, the Department enhanced and completed prescribing provider license editing. Specifically, edit 1237 (Prescriber License Not On NYS License File), and edit 1243 (Prescribing Provider Not In Active Status on Date of Service) were activated for claims filed on paper and via magnetic media (tape and diskette). These edits correspond to MEVS response codes 068 (Invalid Ordering Provider) and 318 (Prescribing Provider License Not In Active Status), which continue to be issued for claims submitted via electronically.

Please note that with the enhancements in the editing, the ordering/prescribing ID, either MMIS ID or license number, entered MUST be for the individual practitioner that has order/prescribed the service not the MMIS ID of a group (ie. Physician Group, Dental Group) of which that individual may be a member. If the group ID is entered in the ordering field, the transaction will reject.

Consult your Pharmacy Provider Manual and Medicaid Update articles featuring license editing for information regarding proper use and entry of prescribing provider license numbers.

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Some providers are misinterpreting eligibility inquiry responses, resulting in the denial of their claims. One of the responses causing confusion is "Family Health Plus."

Family Health Plus (FHPlus) is a New York State health insurance program for uninsured adults. FHPlus covers a comprehensive set of services provided through managed care plans. However, no services are covered by the Medicaid program outside of the managed care plan benefit package.

You should be aware of the meanings of the messages/codes that are returned by eMedNY MEVS.

If you have any confusion about any of the messages/codes received in response to your inquiry, please consult the eMedNY MEVS Provider Manual, or the eMedNY Pro-DUR ECCA Provider Manual (both available at http://www.eMedNY.org) or call CSC Provider Services at (800) 343-9000, before providing services.

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This month's patient educational tools features an article on "Controlling Your Diabetes" and "Key Clinical Activities for Quality Asthma Care."

The Medicaid program encourages practitioners to copy and distribute the following information to their patients and to share them with their colleagues.

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Keeping your blood glucose (sugar) close to normal helps prevent or delay diabetic problems such as eye, kidney, heart, nerve and foot disease.

To keep your blood glucose at a normal and healthy level, it is important to lead a healthy lifestyle and stick to daily routines that involve exercise, good nutrition and glucose monitoring. Your glucose levels will be affected by how much and what kinds of food are eaten daily as well as what kind and amount of activity is done each day. Taking your medications, doing activity and eating at the same times every day are important when trying to keep a normal and stable blood glucose level. A stable blood glucose (sugar) level is the key to preventing or delaying diabetic conditions.

Good blood glucose (sugar) levels are usually in the following ranges:

• 90-130 mg/dl on waking and before meals
• 180 or less - 2 hours after meals
• 100 - 140 mg/dl at bedtime

The following are suggestions on how to maintain a stable blood glucose level:

Food guidelines:

• Eat regular meals - eat 3 meals and 2 snacks at the same time every day. Eating every 4-5 hours will keep your blood glucose level stable.
• Eat less sugar - foods with sugar such as cookies, cakes, pastries, candy and sugared cereals will increase blood glucose levels. Drink water and drinks without added sugar.
• Eat a variety of foods- if you need help with your diet, talk with your doctor about possibly seeing a dietician.
• Eat less fat - avoid fried foods. Foods that are steamed, baked or broiled are healthier. When eating dairy products such as cheese, milk or yogurt, choose low fat or no cream options.
• Eat more high fiber foods such as vegetables, beans and fruit.
• Eat less salt - Salt will increase blood pressure and that could cause circulatory problems. Avoid foods with sodium or salt listed as a major ingredient. Avoid processed foods such as those that come in cans and jars, cold cuts, pickled foods and snacks like potato chips. Do not add salt when cooking. Substitute with herbs and spices.

 

Physical Activity Guidelines:

• Physical activity will help keep blood glucose (sugar) and weight under control. It will also help the circulation and prevent heart and blood flow problems. Start with a little activity everyday and then add a few minutes on a weekly basis. Pick an activity that is enjoyable for you and discuss this with your doctor. Walking, gardening, and biking are generally safe; however, there are some activities that should not be done by diabetics with certain problems. For example, a person with cataracts should not bend over at the waist or lift heavy objects such as weights and someone with poor circulatory problems in the legs may be advised not to hike or dance.
• Do some activity everyday at approximately the same time if possible. It's better to walk 10- 20 minutes daily than to walk an hour once a week.

Medication guidelines:

• Take your prescribed medications at the same time everyday.
  Record blood glucose (sugar) results as well as your medication dose in a diabetic log every day. If your blood glucose (sugar) levels are too high (hyperglycemia) or too low (hypoglycemia), try to figure out why. Maybe you did less exercise on a certain day and so your blood sugar was higher than usual. Or, maybe you ate more food than normal or forgot to take your medication, which would make your glucose levels rise. If you ate less or took more medication than you should have, that would cause low blood sugar. By including these details to explain your glucose results, your doctor will be able to tell if you really need a change in medication doses or if your routine is the problem and you need advice with diet or activity.
• Remember to bring the diabetic logs to your doctor at each visit.
  Remember: food makes glucose levels rise and insulin and exercise make glucose levels fall.

Source: CDC, " Take Charge of your Diabetes", #3rd edition, 2002 pps. 13-18.
American Diabetes Association, Clinical Practice Recommendations 2003
Prepared by the NYSDOH, Office of Medicaid Management, Bureau of Program Guidance, 7/03

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A report titled, "Key Clinical Activities for Quality Asthma Care, Recommendations of the National Asthma Education and Prevention Program" was released in the March 28, 2003 Morbidity and Mortality Weekly Report. The report was developed collaboratively by the Centers for Disease Control and Prevention and the National Asthma Education and Prevention Program (NAEPP). The NAEPP convened a Professional Education Subcommittee to improve the implementation of the Expert Panel Report-2: Guidelines for the Diagnosis and Management of Asthma, released in 1997, and the Expert Panel Report - Update 2002. The purpose of the subcommittee was to develop a report that would define the key clinical activities important to delivering quality asthma care that would result in reducing symptoms and preventing exacerbations, and subsequently reducing the overall national burden of illness and death from asthma. The report is intended to be a companion to the NAEPP Expert Panel Reports.

The Professional Education Subcommittee extracted key clinical activities essential for quality asthma care in accordance with the 1997 EPR-2 guidelines and the EPR--Update 2002. The core set of 10 key clinical activities identified are essential for ensuring that health care delivered to patients with asthma emphasize the prevention aspect of care and address the components of care recommended in the Expert Panel Reports. The action steps listed for each key activity suggest specific ways to accomplish the respective activity. Although the subcommittee report is based on information directed to clinicians, it is not intended to substitute for recommended clinical practices for caring for persons with asthma, nor is it intended to replace the clinical decision-making required to meet individual patient needs. The key clinical activities are not intended for acute or hospital management of patients with asthma but rather for the prevention aspects of managing asthma.

The following chart includes the four essential components of asthma care, key clinical activities, and action steps for providing quality asthma care. The entire key clinical activities report is available at:

 

Components of Care, Key Clinical Activities, and Action Steps for Providing Quality Asthma Care

COMPONENTS OF CARE	KEY CLINICAL ACTIVITIES	ACTION STEPS
Assessment and Monitoring	1. Establish asthma diagnosis	Establish a pattern of symptoms and history of recurrent episodes. Document reversible airflow using spirometry. Rule out other conditions.
	2. Classify severity of asthma	Follow the NAEPP* classification system and recheck at every visit.
	3. Schedule routine follow-up care	See patient at least every 1-6 months according to severity. Perform spirometry at least every 1-2 years for the stable patient, more often for the unstable patient. Review medication use, care plan, and self-management skills at every visit.
	4. Assess for referral to specialty care	Refer to specialty care when referral criteria are met.
Control of Factors Contribution to Asthma Severity	5. Recommend measures to control asthma triggers	Determine exposures and sensitivities, including environmental and occupational triggers. Review ways to reduce exposure to allergens and irritants that provoke asthma symptoms. Discuss smoking avoidance with every patient who smokes or who is exposed to environmental tobacco smoke. Assess for EIB* if symptoms occur during exercise, and provide medication and advice to enable physical activity.
	6. Treat or prevent comorbid conditions	Consider, particularly, rhinitis, sinusitis, GERD*, or COPD*. Provide annual influenza vaccination for patients with persistent asthma.
Pharmacotherpy	7. Prescribe medications according to severity.	Reduce inflammation in patients with persistent asthma with anti-inflammatory medications. Increase medication if necessary; decrease when possible. Provide appropriate medications delivery and monitoring devices. Recommend spacers, nebulizers, or both if needed and consider PFM* for patients with moderate to severe asthma or a history of severe exacerbations.
	8. Monitor use of Beta2-agonist drugs	Reevaluate patients using more than one canister per month of short-acting Beta2-agonist drug.
Education for Partnership in Care	9. Develop a written asthma management plan	Agree on therapy goals. Outline daily treatment and monitoring measures. Prepare an action plan to handle worsening symptoms/exacerbations.
	10. Provide routine education on patient self-management	Teach/review: How and why to take long-term control and quick-relief medications. Correct techniques for inhaler, spacer, PFM*, and nebulizer as indicated. Peak flow/symptom monitoring with patients when appropriate. Factors that worsen asthma and actions to take.
*NAEPP: National Asthma Education and Prevention Program, EIB: exercise-induced bronchoconstriction, GERD: gastroesophageal reflux disease, COPD: chronic obstructive pulmonary disease, PFM: peak flow meter.

The Medicaid Program reimburses for medically necessary care, services, and supplies needed in the diagnosis and treatment of asthma. For information regarding Medicaid payment of these services, please contact the Bureau of Program Guidance at (518) 474-9219.

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Effective August 1, 2003, Medicaid recipients residing in Manhattan will have the option to enroll in a new Special Needs Managed Care Plan, New York Presbyterian System SelectHealth, referred to as OG-NYPS SelectHealth SN. Providers should make note of this new code in their MMIS Provider Manual under the heading "Recipient Other Insurance Codes". Enrollees can call the New York Medicaid CHOICE Helpline at (800) 505-5678 to find out more about Special Needs Plans (SNPs).

This article explains under what circumstances you may continue to provide services to the SNP enrollee and bill MMIS, versus when you must refer the recipient to the SNP to receive services.

Providers must check the eMedNY Medicaid Eligibility Verification System (MEVS) prior to rendering services to determine the recipient's eligibility and the conditions of Medicaid coverage:

• If the Medicaid recipient is enrolled in a SNP, the message will read "Eligible PCP".
• To determine if you can bill MMIS, you must read beyond this message for the insurance and coverage codes, which identify the SNP and the services covered by the respective SNP. Please note that the MEVS coverage codes are general service categories, and do not necessarily mean that a SNP covers all services within the category.

You can bill MMIS and receive payment for any Medicaid services not covered by the SNP.

If you believe that the service is covered by the SNP, you must refer the recipient to the SNP for that service. If, at any time, you are unsure whether or not to provide a service, call the SNP prior to providing the service.

The following chart describes the MEVS messages related to the Medicaid services not covered by the NYPS SelectHealth (therefore, the provider may bill MMIS), and information to assist you in contacting the SNP or local district.

 

MEVS Messages

MEVS Message	Special Needs Managed Care Plan	Medicaid Services not Covered by SNP (bill MMIS) include:*	SNP/ County Contact
OG- AINPQRTVYZ	NYPS SelectHealth SN	Pharmacy, Dental, Methadone Maintenance, COBRA case management, HIV resistance tests, AIDS adult day health care, Personal Care Agency Services, Residential Health Care Facilities, Outpatient clinic chemical dependence treatment (alcohol and substance abuse) except outpatient detoxification	NYPS SelectHealth SN Provider Relations (866) 469-7774 NYC HRA Renee Stout (212) 643-3383

* Please contact the health plan above for additional SNP benefit package information.

If you have questions on how to interpret the MEVS message or need further general eligibility clarification, you should call Provider Services at (800) 343-9000.

If you have billing questions, you may contact Computer Sciences Corporation (CSC) at the following numbers:
Practitioner Services (800) 522-5518, Institutional Services (800) 522-1892, Professional Services (800) 522-5535

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Mental Health Providers: Mental Health Services for SSI/SSI-related recipients enrolled in SNPs

Currently, SSI/SSI-related recipients enrolled in Medicaid managed care plans have mental health services carved out from the benefit package. An "S" is indicated on the MEVS for these SSI/SSI-related recipients when a provider conducts an eligibility verification. Historically, providers have been advised to bill MMIS directly for mental health services for these recipients.

This policy will change for SSI/SSI-related enrollees in SNPs. For SSI/SSI-related SNP recipients, inpatient and outpatient mental health services (as described in "Covered Services" of Appendix K in the SNP model contract) are covered by the plan. Providers are advised that for specific plan ("OG" NYPS SelectHealth), these mental health services are the plan's responsibility when a recipient is indicated as SSI ("S") on the MEVS.

An exception is made for some SSI children in the SNPs. Mental health benefits for some SSI children will be carved out of the benefit package consistent with mainstream managed care for SSI recipients. Please check with the plan to determine status of these children.

Mental Health Specialty Services (as described in "Non-Covered Behavioral Health Services" in Appendix K of the SNP model contract) will remain carved out services for all SNP recipients, including SSI and SSI related SNP recipients. The SNP model contract is available at the following website:

This clarification of mental health services applies to all SNPs, including Healthfirst, MetroPlus, Fidelis HealthierLife and VidaCare, which were announced in previous updates.

Chemical Dependency (Alcohol and Substance Abuse) Providers: SSI/SSI-related recipients enrolled in SNPs will have inpatient chemical dependency services covered by the SNP.

Currently, SSI/SSI-related recipients enrolled in Medicaid managed care plans have inpatient and outpatient treatment and rehabilitation chemical dependency (alcohol and substance abuse) health services carved out from the benefit package (except for detoxification services, which are included in the managed care benefit package). An "S" is indicated on the MEVS for these SSI/SSI-related recipients when a provider conducts an eligibility verification. Providers have been historically advised to bill MMIS directly for inpatient and outpatient chemical dependency (alcohol and substance abuse) services for these recipients.

This policy will change for SSI/SSI-related enrollees in SNPs. For SSI/SSI-related SNP recipients, inpatient chemical dependency (alcohol and substance abuse) services are covered by the plan. Providers are advised that for the specific plan ("OG" NYPS SelectHealth) inpatient chemical dependency services are the plan's responsibility when a recipient is indicated as SSI ("S") on the MEVS.

An exception is made for some SSI children in the SNPs. Consistent with mainstream managed care for SSI recipients, inpatient and outpatient treatment and rehabilitation chemical dependency (alcohol and substance abuse) benefits for some SSI children will be carved out of the benefit package (except for detox services which are included in the managed care benefit package). Please check with the plan to determine the status of these children.

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In a nursing home setting, whenever there are discontinued medications, missed doses, patient transfers, or patient discharges, the nursing home will have "unused" medications on hand. These "unused" medications should be returned to the dispensing/vendor pharmacy. The nursing home pharmacy services provider is required by Title 10 New York Codes, Rules and Regulation (NYCRR) 415.18 (f) to reimburse or credit the nursing home or purchaser of such drug products for the unused medication that is restocked and redispensed. Drugs listed on the "Medicaid Nursing Home Carve-Out List" must be credited back to the Medicaid program. Nursing homes and pharmacies providing pharmacy services to nursing homes are encouraged to review their protocols to assure these requirements are met.

For your information, the regulatory requirements are listed below. They may also be accessed on the Department's web site at:

Title 10 NYCRR 415.18 (f): Return of Unused Medications

(1) When services are provided by a cooperating vendor pharmacy, the facility shall establish policies and procedures which permit either the staff registered pharmacist or consultant registered pharmacist to return to the vendor pharmacy, from which it was purchased, any unused medications or drug products, provided such medication is sealed in unopened, individually packaged, units and within the recommended period of shelf life for the purpose of redispensing and which are in accord with the following provisions:

   (i) Drug products which may be returned are limited to:
       (a) oral and parenteral medication in single-dose hermetically sealed containers; and
       (b) parenteral medication in multiple-dose hermetically sealed containers from which no doses have been withdrawn.

   (ii) The drug products returned show no obvious sign of deterioration.

   (iii) Drug products packaged in manufacturer's unit-dose packages may be returned for redispensing provided that they are redispensed in time for use before the expiration date, if any, indicated on the package.

   (iv) Drug products repackaged by the pharmacy into unit-dose or multiple-dose "blister packs" may be returned for redispensing provided that:
       (a) the date on which the drug product was repackaged, its lot number and expiration date are indicated clearly on the package;
        (b) not more than 90 days have elapsed from the date of the repackaging;
       (c) a repackaging log is maintained by the pharmacy in the case of drug products repackaged in advance of immediate needs.
   (v) "Blister packs".
       (a) Partially used "blister packs" may be redispensed only as returned.
       (b) Partially used "blister packs" may not be emptied and repackaged.
       (c) Additional units of medication may not be added to partially used "blister packs".

   (vi) No drug product dispensed in bulk in a dispensing container may be returned.
   (vii) No medication or drug product defined as a controlled substance in Section 3306 of the Public Health Law may be returned.

(2) The vendor pharmacy to which such drug products are returned shall reimburse or credit the nursing home or purchaser of such drug products for the unused medication that is restocked and redispensed and shall not otherwise charge any individual resident or the State, if a resident is a recipient or beneficiary of a State-funded program, for unused medication or drug products returned for reimbursement or credit.

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The following is a correction of the May 2003 Medicaid Update, Patient Educational Tool article entitled, "Hyperglycemia and Hypoglycemia, Potentially Life Threatening Conditions," in which an error was made.

Under the section Causes of Hyperglycemia:

• "Exercising More Than Planned" was incorrectly listed as a cause.
• "Exercising Less Than Planned" is a cause for hyperglycemia.

We are reprinting the corrected article in its entirety so that you may copy and redistribute the correct information to your patients. We apologize for this error and thank our readers for notifying us.

Please continue to contact the Medicaid Bureau of Program Guidance at (518) 474-9219 with your comments and suggestions on these and future patient educational tools.

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Hyperglycemia or high blood sugar occurs when the blood glucose level is higher than 140 mg/dL before meals. Hyperglycemia can become serious if it is not treated and can lead to Ketoacidosis. Understanding the causes of hyperglycemia will prevent complications and ketoacidosis from occurring.

**Always Follow the Directions Provided To You By Your Doctor or Medical Provider**

The following recommendations were adapted from the CDC:

What is Ketoacidosis?

Ketoacidosis or diabetic coma develops when the body does not have enough insulin to use glucose (sugar) for fuel (energy). Without insulin, the body will break down fats to use for energy. When the body breaks down fats, waste products called ketones are produced. The body cannot tolerate large amounts of ketones and will try to get rid of them in the urine. The body cannot release all the ketones in the urine; as a result they build up in the blood and that can lead to Ketoacidosis.

Source: CDC, "Take Charge of Your Diabetes", 2^nd edition, 1997 pps. 24-30. The American Diabetes Association website, http: www.diabetes.org
Prepared by the NYSDOH, Office of Medicaid Management, Bureau of Program Guidance, 5/03

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Hypoglycemia or low blood sugar occurs when the blood glucose level is higher than 70 mg/dL. Hypoglycemia can become serious if it is not treated and you may have seizures or lose consciousness. It is important to understand the causes of Hypoglycemia in order to prevent complications.

The following recommendations were adapted from the CDC:

1. Test your blood sugar right away, if less than 60 to 70 mg/dL you need to eat 10 - 15 grams of carbohydrates immediately!

   Examples of 10 - 15 grams of carbohydrates:
   2-3 teaspoons (packets sugar)
   ½ cup or 4 ounces fruit juice
   3-5 pieces of hard candy
   ½ cup or 4 ounces of soda *NOT DIET SODA*
   2-3 glucose tablets

2. If you feel like your blood sugar is getting low, but you cannot test right away, eat 10 - 15 grams of carbohydrates IMMEDIATELY!
3. Check your blood sugar again in 15 minutes.
4. Eat another 10 - 15 grams of carbohydrates every 15 minutes until your blood glucose is above 70 mg/dL or your symptoms have gone away.
5. Eating one of the above items will keep your glucose up for only 30 minutes. If your next meal is more than 30 minutes away, you should also eat something else.
     (For example: crackers with a tablespoon of peanut butter or cheese)

1. Always carry a carbohydrate with you so you will be ready to treat a low glucose level.
   (For example: hard candy or glucose tablets)
2. Tell your family, friends and co-workers that you have diabetes.
   Tell them how to know when your blood glucose is low. Show them what to do if you cannot treat yourself. Inform them that someone will need to give you fruit juice, OR soda, OR sugar.
3. If you cannot swallow, someone will need to give you a shot of Glucagon and Call for Help!
   Glucagon is an injectible prescription medication that raises the blood glucose level.
   **Ask your doctor or medical provider if you should have a Glucagon Emergency Kit available.**
   Teach family members, roommates, friends and co-workers when and how to use Glucagon.

Source: CDC, "Take Charge of Your Diabetes", 2^nd edition, 1997 pps. 24-30. The American Diabetes Association website, http: www.diabetes.org
Prepared by the NYSDOH, Office of Medicaid Management, Bureau of Program Guidance, 5/03

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If you are interested in receiving the Medicaid Update via e-mail, please send us a note at MedicaidUpdate@health.state.ny.us and include your name, Medicaid provider ID number, and e-mail address.

Please let us know if you would like to continue to receive a hard copy of the Medicaid Update in addition to the e-mail version. We don't want to burden you with a paper copy if you do not need it.

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If you are enrolled in more than one category of service, you are receiving more than one Medicaid Update. We can eliminate this duplicate mailing.

Please mark the address page of the duplicate Medicaid Updates as duplicate, and mail this page to:

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A federal requirement of the Family Planning Benefit Program (FPBP) is to ensure that recipients in this program have access to primary health care services when needed. Medicaid reimbursement is not available for primary care coverage, but family planning providers can refer recipients to federally qualified health centers (FQHC), FQHC look-alikes, and community health centers.

The following pages contain a current list of FQHCs, FQHC look-alikes and community health centers that are available for referral for recipients in the FPBP for primary care services.

FEDERALLY QUALIFIED HEALTH CENTERS/COMMUNITY HEALTH CENTERS

COUNTY	NAME	ADDRESS	TELEPHONE #
Albany	Whitney Young Health Center	Lark & Arbor Dr. Albany, NY	(518) 465-4771
Bronx	Bronx Lebanon Integrated Services Systems (BLISS) - Grand Concourse - Crotona Park Family Practice - Dr. Martin Luther King Health Center - Family Practice Center - MBD - Bronx Care at Poe -Tiffany Primary Care Practice	1650 Grand Concourse 1591 Fulton Ave. 1265 Franklin Ave. 1276 Fulton Ave. 1690 Bryant Ave. 2432 Grand Concourse 853 Tiffany St.	(718) 518-5060 (718) 901-6471 (718) 503-7700 (718) 901-8236 (718) 901-6480 (718) 817-7900 (718) 378-4764
	Bronx Community Health Network, Inc. -Montefiore Comprehensive Family Care Center - Montefiore Comprehensive Health Care Center -Montefiore Family Health Center -Promesa, Inc.	1621 Eastchester Rd. 305 East 161st St. 360 East 193rd St. 1776 Clay Ave.	(718) 405-8040 ext.2338,2339 (718) 579-2500 (718) 933-2400 (718) 960-7500
	Hunts Point Multi-Service Center	1675 Westchester Ave.	(718) 842-0900
	Hunts Point Multi-Service Center	754 E. 151st St.	(718) 402-2800
	Institute for Urban Family Health - Mt. Hope Family Practice - Parkchester Family Practice - Urban Horizons Family Health Center - Walton Family Health Center	130 West Tremont Av. 1597 Unionport Rd. 50 East 168th St. 1894 Walton Ave.	(718) 583-9000 (718) 822-1818 (718) 293-3900 (718) 583-3060
	Morris Heights Health Center	85 W. Burnside Ave.	(718) 716-4400
	Urban Health Plan	1065 Southern Blvd.	(718) 589-2440
	Comprehensive Community Development Center	731 White Plains Rd.	(718) 589-8324
	Soundview Health Center - Diallo Medical Center - Castle Hill Medical Center - Burnside Medical Center - Delaney Sisters Health Center	731 White Plains Rd. 1760 Westchester Ave. 616 Castle Hill Ave. 165 E. Burnside Ave. 2727 White Plains Rd.	(718) 589-8324 (718) 892-8474 (718) 239-9013 (718) 563-0003 (718) 652-3387
Cattaraugus	Lionel R. John Health Center	987 R.C. Hoag Dr. Salamanca, NY	(716) 945-5894
Cayuga	Family Health Network Central NY	6 South Main St. Moravia, NY	(315) 497-9066
Chautauqua	Cattaraugus Indian Reservation Health	1510 Rt. 438 Irving,NY	(716) 532-5582
Cortland	Family Health Network Central NY	11 Alvena, St. Cortland, NY	(607) 758-3008
	Family Health Network Central NY	North Main St. Cincinnatus, NY	(607) 863-4126
	Family Health Network Central NY	22-24 East Main St. Marathon, NY	(607) 849-3271
Dutchess	Hudson River Community Healthcare at Beacon	249 Main St. Beacon, NY	(845) 831-0400
	Hudson River Community Health	3360 Rte. 343 Amenia, NY	(845) 373-9006
	Poughkeepsie Community Health Center	29 N. Hamilton St. Poughkeepsie, NY	(845) 454-8204
Erie	Community Health Center of Buffalo Inc.	462 Grider St. Buffalo, NY	(716) 898-4449
	Northwest Buffalo Community Health	155 Lawn Ave. Buffalo, NY	(716) 875-2904
Essex	Hudson Headwaters Health Network	24 Fairfield Ave. Schroon Lake, NY	(518) 532-7120
	Hudson Headwaters Health Network Ticonderoga Health Center	102 Racetrack Rd. Ticonderoga, NY	(518) 585-6708
	Moses Ludington Hospital Ronald B. Stafford Community Care	Wicker St. Ticonderoga, NY	(518) 585-6708
Franklin	St. Regis Mohawk Health Systems	Rte. 37 Hogansburg, NY	(518) 358-3141
Hamilton	Hudson Headwaters Health Network	Main St. Indian Lake, NY	(518) 648-5707
Kings (Brooklyn)	Bedford Stuyvesant Family Health Center	1413 Fulton St. Brooklyn, NY	(718) 636-4500
	Brooklyn Plaza Medical Center	650 Fulton St.	(718) 596-9800
	Brownsville Multi-Service Family Health Center	444 Thomas Boyland	(718) 345-5503
	Community Healthcare Network- CABS Center	94-98 Manhattan Ave.	(718) 388-0390
	Community Healthcare Network- Dr. Betty Shabazz Center	999 Blake Ave.	(718) 277-8303
	East New York Neighborhood Family Clinic	2094 Pitkin Ave.	(718) 495-2320
	Family Physician Health Center	5616 Sixth Ave.	(718) 439-5440
	Lyndon B. Johnson Health Complex	276 Nostrand Ave.	(718) 636-2220
	ODA Health Ctr.	14-16 Heyward St.	(718) 852-0803
	Park Slope Health Center	220-13th St.	(718) 832-5980
	Sunset Park Family Health Center of Lutheran Medical Center	150 55th St.	(718) 630-7095
Madison	Family Health Network of Central New York	57-29 Route 13 De Ruyter, NY	(315) 852-3318
	Oneida Nation Health Clinic	2 Territory Rd. Oneida, NY	(315) 829-8700
Monroe	Anthony L. Jordan Health Center	82 Holland St. Rochester, NY	(585) 423-2879
	Oak Orchard Community Health Center	300 West Ave. Brockport, NY	(585) 637-3905
	Westside Health Services	175 Lyell Ave. Rochester, NY	(585) 254-6480
	Westside Health Services	480 Genesee St. Rochester, NY	(585) 436-3040
	Rochester Primary Care Network, Inc. - Clinton Family Health Center - Community Health Network - Downtown Health Care Center - Genesee Health Service - Orchard Street Community Health Center	309 Upper Falls Blvd. 87 N. Clinton Ave. 228 East Main St. 220 Alexander St. Suite 701-704 158 Orchard St.	(585) 546-2360 (585) 244-9000 (585) 423-1880 (585) 922-8003 or 922-8004 (585) 436-9224
New York	Betances Health Center	280 Henry St. New York, NY	(212)227-8401
	Boriken Neighborhood Health Center	2253 Third Ave.	(212) 289-6650
	Charles B. Wang Community Health Center	125 Walker St. 2nd floor	(212) 226-3888
	Community Healthcare Network- Helen B. Atkinson Center	81 West 115th St.	(212) 426-0088
	East Harlem Council for Human Services	2253 Third Ave.	(212) 289-6650
	Renaissance Health Care	215 West 125th St.	(212) 932-6530
	Ryan-NENA Comprehensive Health	279 E. 3rd St.	(212) 477-8500
	Ryan Chelsea Clinton Community Health Center	645 Tenth Ave.	(212) 265-4500
	Settlement Health and Medical Service	212 E. 106th St.	(212) 360-2600
	William Ryan Community Health Center	110 W. 97th St. New York, NY	(212) 316-7953
	Institute for Urban Family Health -Sidney Hillman Family Practice -East 13th Street Family Practice -Heritage Health Care	16 East 16th St. 113 East 13th St. 1727 Amsterdam Ave.	(212) 924-7744 (212) 253-1830 (212) 862-0054
Onondaga	Syracuse Community Health Center	819 S. Salina St. Syracuse, NY	(315) 476-7921
	Syracuse Community Health Center	1938 East Fayette St. Syracuse, NY	(315) 474-4077
	Syracuse Community Health Center	603 Oswego St. Syracuse, NY	(315) 424-0800
Orange	Ezra Choilim Health Center	550 Forest Rd. Monroe, NY	(845) 782-3242
	Family Health Center of Newburgh	3 Washington Ctr. Newburgh, NY	(845) 565-3138
	Hudson Valley Migrant Health Satellite	Pulaski Highway Goshen, NY	(845) 651-2298
	Middletown Community Health Center	10 Benton Ave. Middletown, NY	(845) 343-8838
	Middletown Community Health Center	505 Rte. 208 Suite 11 Monroe, NY	(845) 783-6091
	Middletown Community Health Center	99 Cameron St. Pinebush, NY	(845) 744-2067
	Walkill Valley Health Center	75 Orange Ave. Walden, NY	(845) 778-2700
Orleans	Oak Orchard Community Health Center	301 West Ave. Albion, NY	(585) 589-5613
Oswego	Pulaski Health Center	61 Delano St. Pulaski, NY	(315) 298-6564
Queens	Joseph P. Addabo Family Health Center	67-10 Rockaway Beach Far Rockaway, NY	(718) 945-7150
	Charles B. Wang Community Health Center	136-26 37th Ave. Flushing, NY	(718) 886-1200
	Community Healthcare Network - Queens Center	97-04 Sutphin Blvd. Jamaica, NY	(718) 657-7088
Rockland	Monsey Family Health Center	40 Robert Pitt Dr. Monsey, NY	(845) 352-6800
	Refuah Health Center	728 North Main St. Spring Valley, NY	(845) 354-9300
Schenectady	Schenectady Family Health Services	602-608 Craig St. Schenectady, NY	(518) 370-1441
Tompkins	Family Health Network of Central NY (Dental)	100 Sykes St. Groton, NY	(607) 898-5873
Ulster	Ulster Migrant Health Care	One Paradise Ln. New Paltz, NY	(845) 255-1760
Warren	Health Center on Broad St.	100 Broad St. Glens Falls, NY	(518) 792-2223
	Hudson Headwaters Health Network	11 Cross St. Bolton Landing, NY	(518) 644-9471
	Hudson Headwaters Health Network	6381 State Rt. 9 Chestertown, NY	(518) 494-2761
	Hudson Headwaters Health Network	Ski Bowl Rd. North Creek, NY	(518) 251-2541
	Hudson Headwaters Health Network	3767 Main St. Warrensburg, NY	(518) 623-2844
	Queensbury Family Health Center	14 Manor Dr. Queensbury, NY	(518) 798-6400
	Moreau Family Health	10154 Saratoga Rd. South Glens Falls, NY	(518) 761-6961
Wayne	Rushville Health Center	6600 Middle Road Suite 2200, Sodus, NY	(315) 483-1200
Westchester	Greenburgh Neighborhood Health Center	330 Tarrytown Rd. White Plains, NY	(914) 989-7625
	Mt. Vernon Neighborhood Health Center	107 West Fourth St. Mount Vernon, NY	(914) 699-7200
	Open Door Family Medical Centers Inc.	80 Beekman Ave. N. Tarrytown, NY	(914) 631-4141
	Open Door Family Medical Centers Inc.	165 Main St. Ossining, NY	(914) 941-1263
	Open Door Family Medical Centers Inc.	90 South Ridge St. Rye Brook, NY	(914) 937-8899
	Hudson River Community Health Center (Peekskill Area Health Center)	1037 Main St. Peekskill, NY	(914) 739-8105
	Yonkers Community Health Center	30 South Broadway Yonkers, NY	(914) 968-4898
Yates	Rushville Health Center	2 Ruben Dr. Rushville, NY	(585) 554-6824

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Due to recent legislative change, Medicaid payment for Medicare coinsurance for most Part B services provided to recipients eligible under both the Medicare and Medicaid Programs - dual-eligibles and Qualified Medicare Beneficiaries - will be reduced. Providers were sent a letter, dated June 6, 2003, signed by Kathryn Kuhmerker, Deputy Commissioner of the Office of Medicaid Management, that described the legislative mandate to change the Medicaid program's payment policy for dual-eligibles. The letter explained that effective July 1, 2003, the Medicaid program will no longer pay the full Medicare Part B coinsurance amount for dual-eligibles, but will instead pay 20% of the Medicare Part B coinsurance for most Part B services (except for ambulance, psychologist, and hospital-based/freestanding clinics). A copy of the June 6, 2003 letter follows these questions and answers.

The following questions and answers clarify policy on this program change.

• 1.   Q. How is Medicaid's payment of Part B Medicare coinsurance different for dates of service on or after July 1, 2003?
  • A.  For most Part B services, Medicaid's coinsurance payment is being reduced to 20% of the Medicare Part B coinsurance. This is best shown in examples in the chart that follows:
    
    

    Part B Medicare Coinsurance Before and After 7/1/2003

    	When Medicare pays 80%		When Medicare pays 50%	(Mental Health Practitioner Services ONLY)
    	Before 7/1/2003	On or after 7/1/2003	Before 7/1/2003	On or after 7/1/2003
    Medicare Approved Amount	$100	$100	$100	$100
    Medicare Paid Amount	80	80	50	50
    Coinsurance Billed to Medicaid	20	20	50	50
    Medicaid Coinsurance Payment	20	4	50	10

• 2.   Q. What services are affected?
  • A.   All Medicare Part B services are affected except those provided by ambulances, psychologists, and hospital-based and freestanding clinics certified by DOH, OMH, OMRDD, or OASAS. These services were specifically exempted by the legislature.

• 3.   Q. What caused this change in payment? Is it in effect for a certain timeframe?
  • A.  This is a legislative initiative enacted as part of the 2003 NYS budget. There is no end date.

• 4.   Q. Can the recipient who has both Medicare and Medicaid be billed for any unpaid coinsurance amount?
  • A.   No. The Medicaid/Medicare client must be financially held harmless by participating providers. If a Medicaid provider delivers care or services to a person covered by Medicare and Medicaid, Medicare and Medicaid must be billed. The patient may not be billed.
    Note: Medicaid patients cannot be billed for any covered services, except for Medicaid co-payments (if applicable).
    It is our understanding that Medicare rules prohibit a provider from billing most Medicare/Medicaid eligibles, regardless of that provider's participation in Medicaid. Providers should contact the Medicare program directly for further clarification on this prohibition.

• 5.   Q. Is the July 1 effective date for 'billing dates' or 'dates of service'?
  • A.  For claims with dates of service on or after July 1, 2003, Medicare Coinsurance will be paid under the new law at the reduced amount.

• 6.   Q. Am I still allowed to collect any applicable Medicaid co-payments?
  • A.  Yes. Medicaid recipient co-payments remain in effect.

• 7.   Q. Will providers continue to bill in the same way? How will Medicaid determine what part of the charge went toward the Part B deductible?
  • A.  Providers should continue to bill for the full deductible and coinsurance. Any necessary reductions or corrections will occur in Medicaid's automated claims payment system. Since modifications to the claim payment system will take some time, providers will be notified of any changes in billing procedures in a future issue of the Medicaid Update.

• 8.   Q. What if Medicaid pays more than Medicare for a given service (e.g., some physician office visits, testing strips)?
  • A.  If the Medicaid fee exceeds the 'Medicare Paid' amount, Medicaid will pay up to the Medicaid fee, but no higher than the 'Medicare Approved' amount. Medicaid's payment will not exceed the Medicare coinsurance amount.
    

    Medicare Approved Amount and Medicaid Paid Amount

    	Example 1	Example 2
    Medicare Approved Medicare Paid Medicare Coinsurance Medicaid Fee Medicaid Payment	$100 80 20 110 $20	$100 80 20 90 $10

• 9.   Q. What if the services I provide are not covered by Medicare?
  • A.  You are not affected. Continue to bill as usual.

• 10.   Q. What if the Medicare/Medicaid split for some of my services is 50/50 (mental health services provided by psychiatrists and clinical social workers)?
  • A.  For psychiatrists and clinical social workers, Medicaid will pay 20% of the coinsurance. (See example in Question # 1 above.) Clinical psychologists will continue to receive Medicaid payment for the full coinsurance.

• 11.   Q. Is this new payment policy effective in New York State only?
  • A.  Yes. This legislation affects coinsurance payments for all New York State Medicaid beneficiaries (even if they receive treatment in another State). Coinsurance payment policies for Medicaid beneficiaries from other states are not affected by this legislation.

• 12.   Q. In the June 6 letter, paragraph 3 states that NY Medicaid will continue to pay the full deductible. This appears to be contradicted in paragraph 5 of that letter where it indicates "....may not seek to recover any coinsurance and deductible amounts from Medicaid recipients."
  • A.New York Medicaid will continue to pay the full deductible. Paragraph 5 of the June 6 letter merely restates the principle that Medicaid patients may not be charged for any of the coinsurance and deductible amounts.

• 13.   Q. I am a physician. We have added a suite to perform colonoscopies (echocardiograms, stress testing). This is an 'outpatient' service. Will this new law be applied to these services also?
  • A.  Yes. Services billed with category of service 0460 (physician) will be subject to the new coinsurance payment methodology.

• 14.   Q. I am very unhappy with this new law. How can I disenroll from the NYS Medicaid Program?
  • A.  If you wish to disenroll from the Medicaid program, send your signed, written request to:
    
    NYS Department of Health
    Bureau of Medical Review and Payment
    Attention: Fee-For-Service Provider Enrollment
    Riverview Center 6E
    150 Broadway
    Albany, NY 12204

    As noted in Question #4, it is our understanding that withdrawal from the Medicaid program does not allow you to collect coinsurance and deductible amounts from most Medicare/Medicaid eligible recipients.
    Remaining in the Medicaid program and billing for the coinsurance and deductible maximizes your reimbursement.

• 15.   Q. If I disenroll from the Medicaid program by sending in a letter, what is the effective date of the disenrollment?
  • A.  The effective date of the disenrollment would be the date requested in your letter. If you do not specify an effective date, the date on the letter will be used. If there is no date on the letter, the date the letter is received/date stamped by the department is used.

• 16.   Q. If I disenroll from the Medicaid program and wish to re-enroll in the future, does the original disenrollment adversely affect the new enrollment in any way?
  • A.  No, not in the case of a voluntary withdrawal. However, should you request reinstatement at a future date, the effective date of the new application would not be backdated to the date of your original application.

• 17.   Q. Will disenrolling from Medicaid impact a provider's eligibility/participation in Medicaid Managed Care Plans (e.g., HIP, CDPHP HealthNow, Fidelis Care, etc.)?
  • A.  No. If a provider wishes to disenroll ONLY from fee-for-service Medicaid, they must specify that their enrollment be changed to "non-billing, managed care only" status.

• 18.   Q. As a Medicaid provider impacted by the new coinsurance legislation, can I stop accepting new Medicaid/Medicaid patients and continue to bill for my current patients who have Medicare/Medicaid?
  • A.  Yes. Providers are not obligated to accept new patients.

• 19.   Q. Does this payment policy apply to Part B services provided by a hospital that are billed to and paid by the Part A Medicare carrier?
  • A.  No. Clinic providers (categories of service 0160 and 0287) will continue to receive full coinsurance payment.

• 20.   Q. I am a physician with a speciality in oncology. Does the reduction in Medicaid's payment mean that I will be paid less than my cost for the chemotherapeutic agents?
  • A.  As noted in Question #8, if the Medicaid fee (in this case, your acquisition cost based on invoice) exceeds the "Medicare Paid" amount, Medicaid will pay your acquisition cost

• 21.   Q. Can I give a prescription for the chemotherapy drugs to the patient and have them obtain the drugs at a pharmacy?
  • A.  The Medicaid formulary file is not intended to substitute for drugs normally furnished through a physician's office; therefore, these drugs may not be available from pharmacies.

• 22.   Q. Does this new payment policy apply to services provided by a physician or practitioner to a recipient in an inpatient setting? What if services are provided in a DOH-certified clinic (Article 28)?
  • A.  Yes. For all claims submitted for physician services under category of service 0460, Medicaid will pay 20% of the coinsurance amount-regardless of place of service.

• 23.   Q. Does this change Medicaid's payment of coinsurance impact services provided by private duty nurses? nursing homes/skilled-nursing facilities?
  • A.  No. For services that are not normally covered under Medicare Part B, there will be no change in your current Medicaid reimbursement.

• 24.   Q. Since the system was not ready for implementation of the new law on July 1, how will claim adjustments be made? What information will providers receive as this is accomplished? How will overpayments be recouped by the State?
  • A.  When systems changes are accomplished, claims will be reprocessed creating payment adjustments. Claim-specific data, including recipient, date of service, procedure and payment amounts will be shown on the remittance statement the provider receives. As each claim (dated July 1, 2003 or after) is reprocessed through the system, negative balances will be created.

• 25.   Q. Should I "hold" my billing until the system changes are completed to avoid State recoupments of coinsurance overpayments?
  • A.  No. We do not recommend this because claims submitted after 90 days are considered late submissions. Once a claim has been processed by Medicare, it must be submitted to Medicaid within 30 days of the date the Medicare statement was received by the provider.

• 26.   Q. Are ambulatory surgery and outpatient department services billed by an Article 28 facility subject to the new law?
  • A.  No. Payment for services provided by an Article 29 facility are not affected by the new law.
    If you have additional questions concerning this legislation, please contact the Bureau of Policy Development and Agency Relations at (518) 473-2160.

 

 

 

  STATE OF NEW YORK
  DEPARTMENT OF HEALTH

  

Dear Medicaid Provider:

This is to inform you that the Legislature enacted new legislation, effective July 1, 2003, that reduces the Medicaid payment for Medicare coinsurance for most Part B services provided to dual eligibles and Qualified Medicare Beneficiaries to 20% of the full coinsurance amount, in instances where the Medicare paid amount is higher than the Medicaid fee [Social Services Law, §367-a(1)(d)].

However, this new law requires Medicaid to continue to pay the full Medicare coinsurance amount for the services provided to Medicare Part B dual eligibles and Qualified Medicare Beneficiaries by ambulance providers, psychologists, clinics certified by the Office of Mental Retardation and Developmental Disabilities (Article 16), the Office of Mental Health (Article 31), the Office of Alcoholism and Substance Abuse Services (Article 32), and outpatient and freestanding clinics certified by the Department of Health (Article 28).

The Medicaid program will also continue to pay the full Medicare deductible amount for dual eligibles and Qualified Medicare Beneficiaries.

Please be advised that if the Department is unable to complete the required changes to the Medicaid billing system by the July 1, 2003 effective date, the Department intends to make retroactive adjustments to recoup any payments made in excess of the reduced coinsurance amounts for claims with dates of service back to July 1, 2003.

Providers of care, services, supplies or equipment covered under Medicare Part B and the Medicaid program must accept assignment of the Part B payment, and may not seek to recover any Part B coinsurance and deductible amounts from Medicaid recipients.

If you have any questions concerning this change in the Medicare coinsurance payment, please call 1-800-541-2831.

 

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The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us )

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm