Section 1.1 - Designation and Authority

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

Section 1.2 - Organization for Administration

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

Section 2.1 - Application, Determination of Eligibility & Furnishing Medicaid

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

Section 2.2 - Coverage and Conditions of Eligibility

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

Section 2.6 - Financial Eligibility

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

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

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)

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

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

Section 4.14 - Utilization/Quality Control

• Attachment 4.14-B - Utilization Control in Intermediate Care Facilities

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

Section 4.17 - Liens and Adjustments or Recoveries

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

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)
• Attachment 4.18-A Supplement 1 - Co-Pay Exclusions
• Attachment 4.18-C - Charges Imposed on the Medically Needy for Services—(Co-Pays)
• Attachment 4.18-C Supplement 1 - Copay Exclusions
• Attachment 4.18-D - Premiums Imposed on Low Income Pregnant Women and Infants
• Attachment 4.18-E - Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals

Section 4.19 - Payment for Services

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

Section 4.22 - Third Party Liability

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

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

• Attachment 4.30 - Sanctions for Psychiatric Hospitals

Section 4.32 - Income and Eligibility Verification System

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

Section 4.33 - Medicaid Eligibility Cards to Homeless Individuals

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

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

Section 4.35 - Enforcement of Compliance for Nursing Facilities

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

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

• Attachment 4.38 - Disclosure of Additional Registry Information
• Attachment 4.38-A - Collection of Additional Registry Information

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

• Attachment 4.39 - Definition of Specialized Services
• Attachment 4.39-A - Categorical Determinations

Section 4.40 - Survey and Certification Process

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

Section 4.42 - Employee Education about False Claims Recoveries

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

Section 7.2 - Nondiscrimination

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

Section 7.4 - Medicaid Disaster Relief SPAs

• Attachment 7.4-A - Covid 19 Emergency Relief
• Attachment 7.4-B - Disaster Relief-Vaccine Administration

• 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)