Updated Residential Health Medicaid Policy Manual Posted

The Department of Health (DOH) publishes service-specific Medicaid provider manuals that lay out specific rules governing the provision of care and service to Medicaid recipients. These manuals are posted on the eMedNY website here. Some are accompanied by service-specific billing manuals. In addition, the Medicaid General Policy Manual as well as General Billing Guidelines are resources that outline Medicaid requirements applicable to most provider types. These are available here. DOH notes that the general and service-specific provider manuals, along with the monthly Medicaid Update publication available here, act as effective guides for Medicaid-participating providers.

The Residential Health Services Policy Manual that covers nursing home care was updated on Dec. 13, 2023. The most recent update prior to that was in July 2023, marking the first update since 2006. The December update seems to be concentrated in the sections covering pharmacy, specifically the “Medication” section that begins on p. 12. The updates reflect the recent changes that implement NYRx, the Medicaid Pharmacy program, and include updated links to the Preferred Drug Program that may be applicable for those residents who are not dually eligible for Medicaid and Medicare.

Members using a downloaded version of the manual may want to ensure that they have the most recently updated copy.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841