Section 1.1 - Designation and Authority

• Attachment 1.1 - Designation and Authority (PDF)
• Attachment 1.1-A - Attorney General´s Certification (that DOH is the Single State Agency) (PDF)
• Attachment 1.1-B - Waivers under the Intergovernmental Cooperation Act (PDF)

Section 1.2 - Organization for Administration

• Attachment 1.2-A - Organization and Function of State Agency (PDF)
• Attachment 1.2-B - Organization and Function of Medical Assistance Unit (PDF)
• Attachment 1.2-C - Staffing Summary of Personnel Used in the Administration of the Plan (PDF)
• Attachment 1.2-D - Description of Staff Making Eligibility Determination (PDF)

Section 2.1 - Application, Determination of Eligibility & Furnishing Medicaid

• Attachment 2.1-A - Definition of an HMO that is NOT Federally Qualified (PDF)

Section 2.2 - Coverage and Conditions of Eligibility

• Attachment 2.2-A - Groups Covered and Agencies Responsible for Eligibility Determinations (PDF)
• Attachment 2.2-A Supplement 1 - Reasonable Classification of Individuals Under the Age of 21, 20, 19, and 18 (PDF)
• Attachment 2.2-A Supplement 3 - Method for Determining cost Effectiveness of Care for Certain Disabled Children at Home (PDF)

Section 2.6 - Financial Eligibility

• Attachment 2.6-A - Eligibility Conditions and Requirements (States Only) (PDF)
• Attachment 2.6-A Supplement 1 - Income Eligibility Levels (PDF)
• Attachment 2.6-A Supplement 2 - Resource Levels (PDF)
• Attachment 2.6-A Supplement 3 - Reasonable Limits on Amounts for Necessary or Remedial Care Not Covered Under Medicaid (PDF)
• Attachment 2.6-A Supplement 4 - Methods for Treatment of Income that Differ from Those of the SSI Program (PDF)
• Attachment 2.6-A Supplement 5 - More Restrictive Methods of Treating Resources than Those of the SSI Program - Section 1902(f) States Only (PDF)
• Attachment 2.6-A Supplement 5a - Methods for Treatment of Resources for Individuals with Incomes Related to Federal Poverty Levels (PDF)
• Attachment 2.6-A Supplement 6 - Standards for Optional State Supplementary Payments (PDF)
• Attachment 2.6-A Supplement 7 - Income Levels for 1902(f) States - Categorically Needy Who Are Covered Under Requirements More Restrictive Than SSI (PDF)
• Attachment 2.6-A Supplement 8 - Resource Standards for 1902(f) States - Categorically Needy (PDF)
• Attachment 2.6-A Supplement 8a - More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act (PDF)
• Attachment 2.6-A Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902(R)(2) of the Act (PDF)
• Attachment 2.6-A Supplement 9 - Transfer of Resources (PDF)
• Attachment 2.6-A Supplement 9a - Transfer of Assets (PDF)
• Attachment 2.6-A Supplement 9b - For Transfers of Assets for Less Than Fair Market Value Made On or After February 8, 2006 (PDF)
• Attachment 2.6-A Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship (PDF)
• Attachment 2.6-A Supplement 11 - Cost Effectiveness Methodology for COBRA Continuation Beneficiaries (PDF)
• Attachment 2.6-A Supplement 12 - Resource Policies Permitted Under Section 1902(r)(2) of the Social Security Act (PDF)
• Attachment 2.6-a Supplement 12a - Variations from the Basic Personal Needs Allowance (PDF)
• Attachment 2.6-A Supplement 13 - Eligibility for Qualified Alien/PRWORA (PDF)
• Attachment 2.6-A Supplement 16 - Asset Verification System (TN 09-40) (PDF)
• Attachment 2.6-A Supplement 18 - Methodology for Identification of Applicable FMAP Rates (PDF)

Section 3.1 - Amount, Duration, and Scope of Services

• Attachment 3.1-A - Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy (PDF)
• Attachment 3.1-A Supplement - Prior Approval - Medical and Remedial Care Services Provided to the Categorically Needy (Prior Approval) (PDF) (Must be in Accordance with Regulations of the Department of Health)
• Attachment 3.1-A Supplement 1 - Case Management Services (PDF)
• Attachment 3.1-A Supplement 3 - PACE Services (PDF)
• Attachment 3.1-B - Amount, Duration and Scope of Services Provided to Medically Needy Group(s) (PDF)
• Attachment 3.1-B Supplement - Prior Approval - Medical and Remedial Care Services Provided to the Medically Needy (Prior Approval) (PDF) (Must be in Accordance with Regulations of the Department of Health)
• Attachment 3.1-C - Standards and Methods of Assuring High Quality Care (PDF)
• Attachment 3.1-D - Provisions for Providing Medical Assistance Transportation (PDF)
• Attachment 3.1-E - Standards for the Coverage of Organ Transplant Services (PDF)
• Attachment 3.1-F - Enrollment into Managed Care Entities, and Chronic Illness Demonstration Project (PDF)
• Attachment 3.1-H - Health Homes for Individuals with Chronic Conditions (This Attachment is Broken Down by SPA Numbers) (PDF)
• Attachment 3.1-K - Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to The Categorically Needy (PDF)
• Attachment 3.1-L - Alternative Benefit Plans (PDF)

Section 3.2 - Coordination of Medicaid with Medicare Other Insurances

• Attachment 3.2-A - Medicare -Part A and B - Dual Eligibles (Coordination of Title XIX with Part A and Part B of Title XVIII) (PDF)

Section 4.11 - Relations with Standard Setting and Survey Agencies (DOH, OMH)

• Attachment 4.11-A - Standards for Institutions and Suppliers of Services (PDF)

Section 4.14 - Utilization/Quality Control

• Attachment 4.14-B - Utilization Control in Intermediate Care Facilities (PDF)

Section 4.16 - Relations with State Health and Vocational Rehabilitation
              Agencies and Title V Grantees

• Attachment 4.16-A - Summary of Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees (PDF)

Section 4.17 - Liens and Adjustments or Recoveries

• Attachment 4.17-A - Liens and Adjustments or Recoveries (PDF)
• Supplement to Attachment 4.17-A - Estate Recovery (PDF)

Section 4.18 - Recipient Cost Sharing and Similar Charges (Deductibles,
               Coinsurance Rates, and Copayments)

• Attachment 4.18-A - The Method Used to Collect Cost-Sharing Charges for Categorically Needy Individuals (Co-Payments) (PDF)
• Attachment 4.18-A Supplement 1 - Co-Pay Exclusions (PDF)
• Attachment 4.18-C - Charges Imposed on the Medically Needy for Services–(Co-Pays) (PDF)
• Attachment 4.18-C Supplement 1 - Copay Exclusions (PDF)
• Attachment 4.18-D - Premiums Imposed on Low Income Pregnant Women and Infants (PDF)
• Attachment 4.18-E - Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals (PDF)

Section 4.19 - Payment for Services

• Attachment 4.19-A Part I - Establishing Payment Rates–Inpatient Hospital Care (10 NYCRR 86-1) (PDF)
• Attachment 4.19-A Part II - Setting Payment Rates for Inpatient Services Provided by Hospitals Operated by the New York State Office of Mental Health Part II–Methods & Standards of Setting Payment Rates–Inpatient OMH (PDF)
• Attachment 4.19-A Part III - Methods & Standards of Setting Payment Rates for Hospitals Licensed by the Office of Mental Health–& OASAS (PDF)
• Attachment 4.19A Part IV - Methods & Standards for Setting Payment Rates–Finger Lakes Area Hospitals (PDF)
• Attachment 4.19-A Part V - Hospital Experimental Payment Program (1988-1990) Title XIX (Medicaid) State Plan Amendment (PDF)
• Attachment 4.19-A Part VI - Methods and Standards for Establishing Payment Rates (PDF)
• Attachment 4.19-A Part VII - Rate Setting and Financial Reporting (PDF)
• Attachment 4.19-B - Methods & Standards for Setting Payment Rates for Other Types of Care (PDF)
• Attachment 4.19-B Supplement 1 - Payment of Medicare Part A and Part B Deductible/Coinsurance (PDF)
• Attachment 4.19-C - Payment for Reserved Beds in Medical Institutions (PDF)
• Attachment 4.19-D Part I - Subpart 86-2 - Residential Health Care Facilities (PDF)
• Attachment 4.19-D Part II - Establishing Payment Rates for Intermediate Care Facilities for Individuals with Developmental Disabilities (PDF)
• Attachment 4.19-D Part III - Methods for Establishing Payment Rates, Out of State Services (PDF)
• Attachment 4.19-E - Definition of a Claim by Type of Service (PDF)

Section 4.22 - Third Party Liability

• Attachment 4.22-A - Requirements for Third Party Liability - Identifying Liable Resources (PDF)
• Attachment 4.22-B - Providers Compliance and Threshold Amount (PDF)
• Attachment 4.22-C - State Method on Cost Effectiveness of Employer-Based Group Health Plans (PDF)
• Attachment 4.22-C - Supplement (PDF)

Section 4.30 - Exclusion of Providers and Suspension of Practitioners
               and Other Individuals

• Attachment 4.30 - Sanctions for Psychiatric Hospitals (PDF)

Section 4.32 - Income and Eligibility Verification System

• Attachment 4.32-A - Income & Eligibility Verification System Procedures Requests to Other State Agencies (PDF)

Section 4.33 - Medicaid Eligibility Cards to Homeless Individuals

• Attachment 4.33-A - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals (PDF)

Section 4.34 - Requirements for Advance Directives Under State
               Plans for Medicaid Assistance

• Attachment 4.34-A - Requirements for Advance Directives Under State Plans for Medical Assistance (PDF)

Section 4.35 - Enforcement of Compliance for Nursing Facilities

• Attachment 4.35-A - Enforcement of Compliance for Nursing Facilities - Seriousness of Deficiencies (PDF)
• Attachment 4.35-B - Enforcement of Compliance for Nursing Facilities - Termination of Provider Agreement (PDF)
• Attachment 4.35-C - Enforcement of Compliance for Nursing Facilities - Temporary Management (PDF)
• Attachment 4.35-D - Enforcement of Compliance for Nursing Facilities - Denial of Payment for New Admissions (PDF)
• Attachment 4.35-E - Enforcement of Compliance for Nursing Facilities - Civil Money Penalty (PDF)
• Attachment 4.35-F - Enforcement of Compliance for Nursing Facilities - State Monitoring (PDF)
• Attachment 4.35-G - Enforcement of Compliance for Nursing Facilities - Transfer of Residents with Closure of Facility, Emergency Cases (PDF)
• Attachment 4.35-H - Enforcement of Compliance for Nursing Facilities - Directed Plan of Correction (PDF)
• Attachment 4.35-I - Enforcement of Compliance for Nursing Facilities - Directed In-service Training (PDF)
• Attachment 4.35-J - Enforcement of Compliance for Nursing Facilities - Additional Remedies - State Civil Money Penalties Imposed as a Category 2 Enforcement Remedy (PDF)

Section 4.38 - Nurse Aide Training and Competency Evaluation for
               Nursing Facilities

• Attachment 4.38 - Disclosure of Additional Registry Information (PDF)
• Attachment 4.38-A - Collection of Additional Registry Information (PDF)

Section 4.39 - Preadmission Screening and Annual Resident Review
               in Nursing Facilities

• Attachment 4.39 - Definition of Specialized Services (PDF)
• Attachment 4.39-A - Categorical Determinations (PDF)

Section 4.40 - Survey and Certification Process

• Attachment 4.40-A - Eligibility Conditions and Requirements - Survey and Certification Education Program (PDF)
• Attachment 4.40-B - Eligibility Conditions and Requirements - Process for Investigations of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property (PDF)
• Attachment 4.40-B Supplement 1A - Complaint Program Overview (PDF)
• Attachment 4.40-C - Eligibility Conditions and Requirements - Procedures for Scheduling and Conduct of Standard Surveys (PDF)
• Attachment 4.40-D - Eligibility Conditions and Requirements - Programs to Measure and Reduce Inconsistency (PDF)
• Attachment 4.40-E - Eligibility Conditions and Requirements - Process for Investigations of Complaints and Monitoring (PDF)

Section 4.42 - Employee Education about False Claims Recoveries

• Attachment 4.42 - Employee Education about False Claims Recoveries (PDF)
• Attachment 4.42-A - Oversight (PDF)

Section 7.2 - Nondiscrimination

• Attachment 7.2-A - Methods of Administration - Civil Rights Act (Title VI) (PDF)
• Attachment 7.2-B - Non-Discrimination on the Basis of Handicap - Methods of Administration (PDF)

Section 7.4 - Medicaid Disaster Relief

• Attachment 7.4 - Disaster Relief SPAs

• Attachment 8.1 - MMDL-Cost Sharing
• Attachment 8.2 - MMDL-MAGI
• Attachment 8.3 - MMDL-Other
• Attachment 8.4 - MacPro Eligibility
• Attachment 8.5 - MacPro Health Home
• Attachment 8.6 - MMDL-Alternative Benefit Plan (ABP)
• Attachment 8.7 - MacPro-Other