Summary

UNINSURED CARE PROGRAMS

The Uninsured Care Programs are required to send a notice to participants describing the conditions under which the program can share information with other people and for what reasons.

While there are no formal appeal procedures, recipients can write a letter to the Uninsured Care Program and a representative will handle their complaint, see below Advocacy Procedures for Uninsured Care Programs.

AHIP

AHIP applicants/recipients have the same rights as Medicaid applicants/recipients. MAP must have written authorization from a client before they can release any information regarding that individual’s record.

For detailed information regarding informal advocacy refer to Advocacy, Informal Advocacy. For detailed information regarding Fair Hearings refer to Advocacy, Fair Hearings.

Confidentiality

The “Health Insurance Portability and Accountability Act” (HIPAA) of 1996 requires that the Uninsured Care Programs inform participants about their responsibility to keep all information confidential. The Uninsured Care Programs are required to send a notice describing the conditions under which they can share information with other people and for what reasons. This notice also tells their participants what their rights are under HIPAA. By law, the Uninsured Care Programs must have a recipient’s written permission (“authorization”) to use or give out Protected Health Information for any purpose that is not set out in this notice. Individuals may take back (revoke) their written permission at any time, by sending a written notice of revocation.

Visit https://www.health.ny.gov/diseases/aids/general/resources/adap/englishnotice.htm to read through the confidentiality terms.

Advocacy Procedures for Uninsured Care Programs

There is no formal appeals process for the Uninsured Care Programs. If a recipient has a complaint about denial of coverage, processing or another matter they can write a letter to Uninsured Care Programs and a representative will handle their claim. Issues are resolved on a case-by-case basis. There are no time frames in which DOH must operate to resolve complaints.

Address mail to:

New York State Department of Health
Uninsured Care Programs
Empire Station
P.O. Box 2052
Albany, NY 12220-0052

Advocacy Procedures for AHIP

CLIENT CONSENT RELEASE FORMS

In order for the NYC Medical Assistance Program (MAP) to remain in compliance with the HIPAA rights of privacy, MAP will distribute a Notice of Privacy Practices (NPP) with all notices of acceptance and renewal to Medicaid applicants. These notices inform individuals of their privacy rights as they relate to the personal health information MAP maintains on file. MAP must have written authorization from a client before they can release any information, including application and recertification, regarding that individual’s record to an advocate/attorney.

It is recommended advocates keep a copy of the form, so when calling MAP, they can fax the copy to appropriate parties to ensure they will be able to access information.

Call the Medicaid Information Help Line at 800-541-2831 for answers to HIPAA inquiries/requests.

CONFERENCES

A conference is an informal meeting at the local Medicaid center when MAP has made a determination affecting an individual’s benefits or request for benefits. A conference is typically held at the center where the case is located with an MAP employee who has the authority to make decision on behalf of MAP.

A conference may be requested at any time as well as requesting a fair hearing. Requests should be made at the local Medicaid office.

FAIR HEARING

A fair hearing must be requested within 60 days of the date on the Notice of Intent on a Medicaid case.

An individual/representative can request a fair hearing by telephone, fax, mail, online or in person. To obtain a fair hearing request form to be used for fax or mail go https://otda.ny.gov/hearings/request. A fair hearing should be requested by mail only if no other means is available.

By Telephone:
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
518-474-8781
800-342-3333

By Fax:
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
518-473-6735

By Mail:
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
P.O. Box 1930
Albany, NY 12201-1930

Online:
https://otda.ny.gov/hearings

In Person:
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
14 Boerum Place
Brooklyn, NY 11201

Expedited Hearing

To request an emergency fair hearing call 800-205-0110, or go in person, as indicated above. The individual should be given the hearing date and time at the time of their call.

FAIR HEARING DECISION

Refer to Advocacy, Fair Hearings, Fair Hearing Decision

COMPLIANCE

If the applicant/recipient has won a fair hearing, Medicaid is required to comply promptly with the decision. If the applicant/recipient has not been contacted by Medicaid within 10 days of receiving the hearing decision, write or go with a copy of the decision to the Medicaid Fair Hearing Compliance Unit at 111 Livingston Street, 4th floor, Brooklyn, NY.