MEDICAID CONSULTING
Client's engage the LEVY LAW & MEDIATION FIRM, P.C. when their home health services are reduced or denied.
In the event a Community Medicaid Applicant's hours are reduced as a result of adverse annual assessment, then the remedy is to Appeal the adverse Decision.
The first level of Appeal will be to the Management Long Term Care (MLTC) agency that provides the Applicant’s with home health care services. The problem with this Appeals process is that the MLTC is paid the same reimbursement amount by Medicaid, whether they provide 4 hours or 24 hours Home Health Care for the Applicant. This unfortunately skews the system in favor of the MLTC.
In the event the MLTC affirms it's initial Decision, then the next step is to request a Second Appeal by submitting the requisite form provided with the Notice of Adverse Decision to request a Fair Hearing with the NYS Office of Temporary and Disability Assistance (OTDA). The Appeal needs to be timely faxed to OTDA. Notice will be mailed with a case number and the date fo the hearing. An Administrative Law Judge will be assigned to the case and the Applicant is given an opportunity to submit supporting documentation, which should include medical evidence and case law setting forth the factual and legal basis for reinstatement of Medicaid Benefits. Witnesses may be called to testify. Preferably a treating physician of the Applicant.
The LEVY LAW & MEDIATION FIRM, P.C. maybe engaged and retained to represent the Applicant to Appeal the adverse Decision by drafting and submitting documents to support the Applicant’s Appeal and appear (during the Pandemic via Microsoft Teams) on behalf of Client’s before the OTDA’s Administrative Law Judge to advocate for reinstatement of the reduced home health care hours so that the Applicant can age safely in their homes.
In the event a Community Medicaid Applicant's hours are reduced as a result of adverse annual assessment, then the remedy is to Appeal the adverse Decision.
The first level of Appeal will be to the Management Long Term Care (MLTC) agency that provides the Applicant’s with home health care services. The problem with this Appeals process is that the MLTC is paid the same reimbursement amount by Medicaid, whether they provide 4 hours or 24 hours Home Health Care for the Applicant. This unfortunately skews the system in favor of the MLTC.
In the event the MLTC affirms it's initial Decision, then the next step is to request a Second Appeal by submitting the requisite form provided with the Notice of Adverse Decision to request a Fair Hearing with the NYS Office of Temporary and Disability Assistance (OTDA). The Appeal needs to be timely faxed to OTDA. Notice will be mailed with a case number and the date fo the hearing. An Administrative Law Judge will be assigned to the case and the Applicant is given an opportunity to submit supporting documentation, which should include medical evidence and case law setting forth the factual and legal basis for reinstatement of Medicaid Benefits. Witnesses may be called to testify. Preferably a treating physician of the Applicant.
The LEVY LAW & MEDIATION FIRM, P.C. maybe engaged and retained to represent the Applicant to Appeal the adverse Decision by drafting and submitting documents to support the Applicant’s Appeal and appear (during the Pandemic via Microsoft Teams) on behalf of Client’s before the OTDA’s Administrative Law Judge to advocate for reinstatement of the reduced home health care hours so that the Applicant can age safely in their homes.