Medicaid coverage is critical to ensuring access to services, whether OPWDD services, healthcare services, medications, or durable medical equipment and supplies. For this reason, it is incumbent upon all providers to work together to ensure we are collectively supporting the people who rely on us all.
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Care Managers
Care Managers are responsible for assisting individuals who reside in non-certified settings to ensure their Medicaid coverage remains active and all necessary recertification activities/requests for information and documentation by DSS/HRA are attended to and provided timely. The level of assistance provided will vary based on the person’s preferences; in some cases, the person/family may require a great deal of assistance with the process, while in others, they may not need or want as much involvement from the Care Manager. The most important thing is to make sure that the people Care Managers support are aware of the upcoming need to recertify and the assistance that is available to them.
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Residential Providers
Residential provider agencies retain primary responsibility for maintaining Medicaid coverage and other benefits for people that reside in their certified residences; however, this should be seen as a team effort with the Care Managers monitoring to ensure that coverage remains active. Care Managers in these situations should ensure that the residential provider takes the appropriate steps to secure ongoing Medicaid coverage, including submitting recertification packets and responding timely to inquiries or requests for documentation by DSS/HRA. While the residential provider is ultimately responsible, it is in the individuals’ best interest for all providers to work together for the benefit of the person.
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Tips to Help Prepare for Recertifications
Check individuals’ mailing addresses on file with Medicaid to ensure that they are accurate and up-to-date. If someone has moved, their address must be updated with DSS/HRA so that their recertification packets and other notices get to them successfully. Please be aware that Medicaid mail is NOT forwarded by the Post Office; if mail is returned to them, the associated Medicaid case will be closed.
Notify individuals and advocates as appropriate about upcoming recertification requirements so that everyone within a person’s circle of support understands the changes and everyone’s responsibilities.
Be prepared to provide income and resource information as part of the recertification process – remember that there are significant changes to Medicaid income and resource limits, effective January 1, 2023, that should positively impact Medicaid eligibility for many, effectively lowering or eliminating spenddown amounts.
Know what to do if a case is closed inappropriately:
File promptly for a Fair Hearing with Aid to Continue (AC) within 10 days of the notice date. Requesting AC will allow Medicaid coverage to continue until the Fair Hearing is held and a decision is made. After the 10-day window, a Fair Hearing can still be requested within 60 days of the notice date, but AC is not an option. We recommend that AC be requested, regardless, in case they do honor the request (never hurts to ask!).
Watch the April 24, 2024 Provider Webinar!Medicaid Eligibility: Maintaining Benefits for the Intellectually and Developmentally Disabled in New York State
Need Provider Assistance?
The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.
Once again, Partners Health Plan (PHP) wants to provide an update regarding the NYS Workforce Stabilization Longevity and Retention Supplemental pass-thru payments that we will be distributing on behalf of NY State.
We have been notified that the Department of Health (DOH) has received the necessary approval to fund the two Calendar Year 2021 ARPA Workforce Stabilization Initiatives – the cost-based Longevity Payment and the survey-based COVID-19 Service Payment. DOH has provided PHP with the specific provider award amounts to be paid to each provider. PHP is scheduled to receive the related pass-thru funds from DOH in the third week of November 2022. We will remit the payments to providers according to the list provided by the DOH shortly thereafter.
As we previously informed you, the payments will be made in the form of a check. Unless we have been provided payment instructions pursuant to our previous solicitations specific to this process, payments will be sent based on provider-payment information from our claim system.
More details will follow as we get closer to the third week of November.
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NYS Workforce Stabilization Longevity and Retention Supplemental Pass-thru Payments Request for Provider Billing Information Once again, Partners Health Plan wants to provide an update regarding NYS Workforce Stabilization Longevity and Retention Supplemental pass-thru payments that we will be distributing on behalf of NY State. We have not received guidance with respect to timing since our July 6, 2022 communication to you. As always, we will immediately share any updates that are received from the State.
Once again, Partners Health Plan wants to provide an update regarding NYS Workforce Stabilization Longevity and Retention Supplemental pass-thru payments that we will be distributing on behalf of NY State.
We have not received guidance with respect to timing since our July 6, 2022 communication to you. As always, we will immediately share any updates that are received from the State.
As a reminder, the Workforce Stabilization Longevity and Retention Supplemental pass-thru distributions will be made via hard-copy check. Because we want to make sure the funds are received timely, we have been collecting addresses from providers specifically for the mailing of this payment. If we do not receive your billing address confirmation form, the Workforce Stabilization Longevity and Retention Supplemental pass-thru payments will be mailed to the billing address we have on file in our claims system.
If you would like to guarantee that the checks are distributed correctly please complete the form at the following link: → Provider Billing Address Form.
May 14, 2025 Provider Webinar - Trauma Informed Care
Our Trauma Informed Care Webinar provides information on trauma types, how to recognize the signs and symptoms that someone may have experienced a traumatic event, and person-centered ways to support someone who has experienced a traumatic event. This training also discusses resources that can be utilized to access Trauma Informed Care.
PRESENTED BY: Melissa Ackernecht, Behavioral Support Specialist;Trisha Chapman, Director of Specialized Services; Brittany Miske, Vice President of Healthcare Management and Clinical Support
February 12, 2025 Provider Webinar - Winter Cardiovascular Wellness
Cardiovascular conditions are commonplace for many individuals with IDD. Add the stress of winter weather and you have the perfect storm for complications. In this webinaryou will learn about the effects of cold weather on CV disease and individuals with IDD.
PRESENTED BY: Brittany Miske, Vice President of Healthcare Management and Clinical Support
November 20, 2024 Support Broker Training - Staying Healthy & Independent
In this webinar you will learn how to best help individuals in Self-Direction, and those that support them such as their Brokers, Family Liaisons, families, and other team members maintain wellness and connected to our community. This program will assist with better understanding that we are all just one adverse health event away from losing some of our independence and having to make significant changes to our lifestyle. The discussion focuses on the importance of self-advocates to take charge of their health, to participate whenever possible, to understand their wellness journey, and to plan for the future. Examples will be provided on a whole-person care model that is built to assist individuals to remain healthy, avoid hospitalizations, and stay in the environment of their choice.
PRESENTED BY: Karleen Haines, Chief of Advocacy; Annrose Bacani, Director of Outreach and Enrollment
October 23, 2024 Supported Decision Making — A Less Restrictive Alternative to Guardianship
In this virtual presentation, join Supported Decision Making-NY Associate Director Joan Cornachio in a conversation to learn how supported decision-making is an effective process for many individuals on the spectrum and with other developmental disabilities in New York, as they strive for more inclusive and self-determined lives. The presentation will explain how the SDMNY facilitation process works and the role and responsibilities of Supporters. An overview of the impact of the SDMA lawwill also be covered.
PRESENTED BY:Joan Cornachio,Supported Decision Making-NY Associate Director
September 25, 2024 PHP Quality Initiatives Provider Webinar
Learn how Partners Health Plan (PHP) and Providers can collaborate together to assist members with IDD achieve quality of health outcomes. This webinar will discuss key Quality of Health initiatives implemented for members enrolled with PHP. Join our webinar to learn more about the following:
HEDIS Quality Measures
Medical Record Documentation
CAHPS Survey
Health Outcomes Survey
Transitions of Care
Quality Improvement Programs
PRESENTED BY: Premila Kumar, Chief of Quality Initiatives; Diane Marrone, Chief of Care Management
September 16, 2024 Support Broker Webinar: Guardianship
For those supporting and advocating for individuals with intellectual and/or developmental disabilities (IDD), understanding the guardianship process is crucial.
In our upcoming Support Broker training, Giselle Peter, Regional Care Manager Director for Partners Health Plan, and Lisa Miller, Care Manager Director for Care Design NY, will provide an in-depth overview of guardianship, including what it is, how it functions, and why it may be necessary.
This presentation is designed to give you deeper insight into the legal procedures for establishing guardianship and the various types of guardianship that exist under New York State law. We'll also cover best practices for supporting people under guardianship arrangements, providing you with the expertise you need to help individuals with IDD and their caregivers navigate the process.
PRESENTED BY: Giselle Peter, Regional Care Manager Director for Partners Health Plan & Lisa Miller, Care Manager Director for Care Design NY
July 23, 2024 Provider Webinar: Whose Life Plan is it Anyway? - Collaborative Best Practices for Life Plan Develop
In this webinar, we share Care Management best practices for ensuring providers are engaged and your valuable input is included in individuals’ Life Plans. Care Design NY and Partners Health Plan’s Care Management teams review the collaborative Life Plan process and the connection between the Life Plan and Staff Action Plan.
PRESENTED BY: Danielle Mazza, AVP of Care Management for Upstate NY; Ernie McNutt, AVP of Care Management for Downstate NY
April 25, 2024 Provider Webinar: Medicaid Eligibility: Maintaining Benefits for the Intellectually and Developmentally Disabled in New York State
This webinar was in collaboration with Care Design NY and focused onchanges to Medicaid eligibility and recertifications, as well as the unwinding of the Public Health Emergency (PHE) as it relates to Medicaid coverage.
PRESENTED BY: Kristina Cunningham,Assistant Vice President of Member Benefits and Enrollment
October 26, 2023 Provider Webinar: Best Practices for IDD-Tailored Medical Care
This webinar was The webinar was in collaboration with Care Design NY, and focused on how individuals with Intellectual and Developmental Disabilities (IDD) have unique patterns of health-related risks and conditions and how they can benefit from some distinct approaches to annual wellness and healthcare maintenance. Based on a review of the literature, this presentation summarized some practical approaches to supporting and improving the quality of health of those with IDD.
PRESENTED BY: Stephen Merahn, MD, Medical Director
August 22, 2023 Provider Webinar: Medicaid Eligibility: Maintaining Benefits for the Intellectually and Developmentally Disabled in New York State
This webinar was in collaboration with Care Design NY and focused onchanges to Medicaid eligibility and recertifications, as well as the unwinding of the Public Health Emergency (PHE) as it relates to Medicaid coverage.
PRESENTED BY: Kristina Cunningham,Assistant Vice President of Member Benefits and Enrollment
March 22, 2023 Provider Webinar: What is IDD Care Management and What Does It Mean To Me?
This webinar was in collaboration with Care Design NY and focused on how Care Management is different when in support of someone with an Intellectual or Developmental Disability (IDD) and the importance of collaboration between IDD Care Managers and the provider community.
February 24, 2022 Provider Webinar in Collaboration with Care Design NY: The Life Plan Process
This webinar reviewed the CDNY & PHP alignment, the Life Plan process, the CDNY and PHP escalation process, and how to ensure effective communication and timely resolution.
October, 26, 2021 Provider Webinar: Important Billing and Claims Updates and Reminders
This webinar reviewed Partners Health Plan’s Care Management model, the Life Plan, and important billing and claims reminders, how to appeal a claim denial and timely filing guidelines.
Are you looking for a direct channel to useful state resources
relevant to participation in Medicaid and other health programs?
Need Provider Assistance?
The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.
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Click the link above to continue or click outside of the box to CANCEL
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Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
Click the link above to continue or click outside of the box to CANCEL
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
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Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.
