NYS Department of Health Prior Approval Out-of-State Medicaid Placements

Special Populations within Long Term Care

Purpose:

The purpose of prior approval for out of state placement is to ensure all reasonable possibilities for instate placement of a New York Medicaid member with special care needs are exhausted before consideration to an out-of-state placement is given.

Prior Approval Process:

Involves onsite screen by provider agencies, prior approval proposal package including relevant medical records, review of facilities already referred to and reason for denial, review of available in state options with suggestions for additional New York State options given whenever possible and review of clinical components of proposed plan of care for out of state facility.

A member's status is monitored via the documentation necessary to obtain an initial prior approval or renew an existing prior approval, in order to facilitate repatriation to an appropriate level of care in New York State as soon as practicable.

General Diagnostic Groups Served Through this Process:

Traumatic Brain Injury, Neurobehavioral Disorders, Huntington's Disease, multiple medical co-morbidities that cannot be successfully treated in New York State due to the uniqueness of the constellation of needs.

Additional information can be found in the OOS SNF section of the Residential Health Manual.

Questions should be directed to1-800-342-3005 option 4 or FFSOOS@health.ny.gov