Service Authorization and Appeals

For Medicaid Managed Long Term Care Plans


  • 42 CFR 438 MMC Service Authorization and Appeals – Partial, MAP, MA

Guidance for Health Plans

DOH Model Notices for Medicaid Managed Long Term Care Plans (Partial, MAP, MA)

Managed Long Term Care plans are required to submit templates for these notice types to the Department for approval prior to use. Templates will only be accepted from the health plan and must include a unique identifier on each page. A completed and signed cover sheet must accompany each template submitted. Submit templates and cover sheets to:

Contact for any questions on this page.