DOH Issues Memo to County Commissioners Clarifying Immediate Need Policy for Home Care
The New York State Department of Health (DOH) Office of Health Insurance Programs (OHIP) issued a Local Commissioners Memorandum on March 26th. The document addresses Frequently Asked Questions (FAQs) regarding Immediate Need and the requirement to expedite Medicaid eligibility and needs assessments for Personal Care Services or Consumer Directed Personal Assistance Services (CDPAS).
The memo covers the following issues:
- Documents necessary for an expedited Medicaid eligibility determination request – Physician's order, Attestation of Immediate Need, and Medicaid application or request for increase in coverage. An applicant or recipient’s request is considered self-authenticating.
- Does practice of private pay for home care impact a request for expedited Medicaid eligibility determination?
- Does third party insurance impact the request?
- Local district assessors may complete an assessment for an individual in a Skilled Nursing Facility (SNF).
- A physician supplying the order to support a request does not have to be enrolled in the New York State Medicaid program. However, the services based on the assessment must be authorized by a Medicaid-enrolled physician.
Questions should be directed to your local district Medicaid liaison at 518-474-8887 (outside of New York City) or 212-417-4500 (New York City).
Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871