GIS 12 MA/029: Hurricane Sandy – Authorization and Eligibility Verification Processes During the State of Emergency

To: Local District Commissioners, Medicaid Directors

From: Jason Helgerson, Medicaid Director

Subject: Hurricane Sandy – Authorization and Eligibility Verification Processes During the State of Emergency

Effective Date: Immediately

The purpose of this GIS is to advise local departments of social services (LDSS) of the implementation of specific authorization and eligibility verification processes in effect during this State of Emergency.

Due to the potential impact of Hurricane Sandy, the Fee-for-Service Medicaid Program is implementing the following processes until the State of Emergency has ended. The State of Emergency will be determined by the Local Department of Social Services and the State.

  1. During the State of Emergency, Fee-for-Service Medicaid will relax Prior Authorization requirements for the provision of urgent services.
  2. Providers will not be required to request authorization to treat enrolled beneficiaries for the provision of urgent services and will be reimbursed accordingly.

In the event that telecommunication failures prevent access to the Medicaid Eligibility Verification System, the Medicaid ID card will suffice as eligibility verification. If access to the eMedNY system prevents real time claim adjudication, pharmacies should dispense emergency supplies as necessary.

Questions regarding this information should be referred to the CSC Call Center at 800-343-9000.