New York State Medicaid State Plan
Table of Contents
Section 1 – SINGLE STATE AGENCY ORGANIZATION
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 – COVERAGE AND ELIGIBILITY
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 – Services: GENERAL PROVISIONS
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 – GENERAL PROGRAM ADMINISTRATION
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