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(sec 17). Earlier,NYLAG posted COMMENTSto theState's preliminaryproposal to amend the 1115 waiver to apply the LOOKBACK to MLTC enrollment. close case, combine case, add/remove individual, notify of death, change in immigration status, CMS"Completeness letter" dated April 7, 2021 -(Web)-(PDF). review the CHA, examine the member, either in person or through a telehealth modality, the member and, if necessary, consult with providers and others who may have insight into the member's needs; ensure that the current diagnoses and medications are documented accurately and thoroughly; attest to the member's need for assistance; indicate whether the member is self-directing, or has identified an appropriate self- directing other; indicate if the member can complete the consumer's roles and responsibilities if they are authorized for and enroll in CDPAS; and. Telehealth - synchronous live interactive video teleconference. The MMC plan does not need to refer cases to the IRP if the amount of service in excess of 12 hours a day, on average, is ordered pursuant to a Fair Hearing decision, external review decision, or by any other court of competent jurisdiction. Click here for agenda and here to download materials. The new NYIA process will involve a Community Health Assessment (CHA) or Independent Assessment (IA) by a registered nurse as well as a second step, consisting of an Independent Practitioner Panel (IPP) which includes an examination by a clinician a clinical appointment (CA) to determine the number of home care hours to be provided to applicants for Medicaid-covered individuals seeking personal care services (PCS), consumer directed personal assistance services (CDPAS) and/or Managed Long Term Care (MLTC) Plan enrollment. WebPlease note: Internet Explorer is not supported by Request for Review Of Property Value This is an error of fact or observation that occurred when the assessment was performed that is not subject to the assessor's clinical judgment. nyia assessment request form does delta transfer baggage on connecting international flights; mga suliranin ng panitikang pilipino; Mon - Sat 10:00am - 7:00pm / Sunday - CLOSED Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser, Consumer Directed Personal Assistance Regulations, MMC Guidance - Process for Expedited Request for Assessment and the New York Independent Assessor (NYIA) -, MMC Guidance - ADDITIONAL REVISION Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -, MMC Guidance - REVISED Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -. Seethis link. State regulations were amended effective Nov. 8, 2021. However, if they try to enroll in an MLTC plan BEFORE passage of 120 days, they will be required to go through NYIA. To schedule an evaluation, call 855-222-8350. nyia assessment request form 0522 Visit george strait stroke. For standard requests, the MMC plan will no longer conduct a separate CHA to authorize PCS and/or CDPAS. WebAssessment and Valuation Forms Business Tax Forms Assessment and Valuation Forms Documents on this page are provided in pdf format. CMS"Completeness letter" dated April 7, 2021 - (Web)-(PDF). determine if the member's medical condition is stable to receive PCS and/or CDPAS. (Section 11). On Sept. 14, 2020, NYLAG submittedComments posted here to the proposed state regulations that would implement the Home Care Eligibility Changes and Changes in Assessments. After submitting the fax, if you do not hear back call the above numbers or emailhcspinquiries@hra.nyc.gov. The NYIA will schedule both a CHA and a Clinical Appointment for the member and both will be completed within 14 days of contact with the NYIA. Keep in mind that there are certain asset transfers that will be deemed exempt from transfer penalties. Assessment Request For this service, contact the LDSS agency and provide a copy of the Outcome Notice, and ask for Housekeeping. Ashley Callingbull Husband Ryan Burnham, The intuitive drag&drop interface makes it easy to include or relocate fields. The assessment helps us understand how a persons care needs affect their daily life. 3. Most of our recommendations were rejected. Works under general supervision. Questions can be sent to independent.assessor@health.ny.gov. Applications filedbefore the effective date -- whatever it is -- will have no lookback. hbbd``b`$TqM@\aR b^cXHD y :H @& n)1 uKAb SL$XA0Rb^@@F10I?m 5 After assessments are conducted, an Independent Practitioner Panel (IPP) composed of physicians, nurse practitioners, and physician assistants will conduct clinical appointments and issue . Using the free Adobe Reader, you will be able to open the forms, type in your data, and print a completed form to mail to the appropriate address. LDSS representative initiates a three-way call to the NYIA Operations Support Unit (OSU) at 855-665-6942 with the consumer on the line. Consumers can appoint a representative to talk to NYIA on their behalf. SeeCompleting fill-in formsabove for more information on how to complete the fill-in form before saving. For members seeking services within the MMC plan, upon completion of both the CHA and the PO, the individual will receive a notice form NYIA indicating whether their health condition is stable to receive PCS and/or CDPAS in their home. The NYIA will continue to use this tool for the independent assessments. NYIA sends LDSS representative anauto-generated email confirmation that the form has been received. Webnyia assessment request form 0522 %PDF-1.5 % Maximus seeks to fill multiple open positions on the NYIA and IPP teams, where you can play a critical role in helping some of the states most vulnerable people access services that can Instead of a nurse assessment twice a year, MLTCs will now assess once a yearunless there is a need for an additional assessment. DOH said it did not intendto impose a lookback for the OPWDD, TBI, or NHTDW waivers. WebNYIA Assessment Request Form 0522 Download. 04. Schedule your assessment at a time that is convenient to you. They will indicate whether there is a need for services and whether they believe that the individual is medically stable to receive PCS and/or CDPAS. 1 0 obj If the IPP clinician determines the individual is not medically stable, then the MMC plan may not authorize PCS and/or CDPAS. endstream endobj 96 0 obj <>>> endobj 97 0 obj <. OnNov 8, 2021,State DOH posted a webinar clarifyingwhich of the recent personal care and CDPAP regulation changes will go into effect on Nov. 8, 2021. Only MAP plans provide Medicaid long-term care services). A bill has been proposed by Assembly Health Chair Richard Gottfried and Senate Health Chair Gustavo Rivera that would repeal the ADL thresholds, whichadvocates contend discriminates against people with various disabilitiies who will be denied services. This page is made available by the lawyer for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. See NYLAG Memo in support of this bill - See bill at A5367/ S5028. The regulations have an effective date of Nov. 8, 2021, but they will not all be implemented on that date. How Do I Qualify for Community Based Long Term Services and Supports? The maximum hours forstand alone Housekeeping services is 8 hours/week. 3 0 obj Property owners have the right to challenge the Department of Finances assessments and correct erroneous information associated with their properties. Hochul's proposed Budget for 2022-23 abandonedthis effort and instead just issue guidelines and standards for plans and local districts to make appropriate and indivdiualizeddeterminations for utilization. To qualify for personal care or CDPAP, and for enrollment into MLTC plans, new applicants after the effective date, which is now likely to be in 2022, must need physical maneuvering with more than two ADLs, or for persons with dementia or Alzheimer's diagnosis, need at least supervision with more than one ADL. (People already receiving services before the effective date will be"grandfathered" in). Consumer/rep calls NYIAat 1-855-222-8350to schedule TWO assessments: --Consumers can appoint a representative to talk to NYIA on their behalf. The Biden Administration toldState governors that states will receive 60 days advance notice before the PHE ends. Even now, before these changes are implemented, those who need highhours such as 24-hour care must fight decisions by MLTC plans that they must be permanently placed in a nursing home. Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 Excelsior Pass/Excelsior Pass Plus, Addressing the Opioid Epidemic in New York State, Drinking Water - Boiling Water and Emergency Disinfection Info, Health Care and Mental Hygiene Worker Bonus Program, Learn About the Dangers of "Synthetic Marijuana", Maternal Mortality & Disparate Racial Outcomes, NYSOH - The Official Health Plan Marketplace, Help Increasing the Text Size in Your Web Browser, Consumer Directed Personal Assistance Regulations, MMC Guidance - Process for Expedited Request for Assessment and the New York Independent Assessor (NYIA) -, MMC Guidance - ADDITIONAL REVISION Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -, MMC Guidance - REVISED Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -. To arrange for the NYIA to appear as a witness, the MMC plan must call the OSU to notify NYIA of the fair hearing request. Now, working with a Dcss 0522 takes a maximum of 5 minutes. Per attached 3/2022 memo may be faxed to (917) In fact, you can highlight that support in your written submissions, since aides and support teachers are there to help students. 2, 20). This is part of the push to the full capitation mega-plans that cover both Medicaid and Medicare. The implementation date of the New York Independent Assessor is now anticipated to begin on May 16, 2022. TIP: On the Supplement A DOH 5178A form (link here), Question 8 on page 3 asks you to check one of THREE boxes to indicate the type of care and services applicant is seeking. Schedule your assessment at a time that is convenient to you. They must be prescribed by an independent physician under contract with DOH, and approved by an independent assessor under contract with DOH instead of the local district Medicaid agency and MLTC plan. ability %, 16.96 , the details of the crime, the After reviewing the CHA and PO, if the MMC plan has a material disagreement regarding the outcome of the independent assessment, the MMC plan may use the same NYIA CHA Variance Form to submit a material disagreement. Select File, select Open, locate the form, and double-click on the saved form file name. Comply with our easy steps to get your Dcss 0522 well prepared quickly: Pick the web sample from the catalogue. To find the form, go to https://nyia.com/en/consent. If you are having problems downloading or printing forms,see Adobe Reader - Requirements and Download Information. Who can Download. DOH will monitor MMC plan participation in coordinating assessments through the NYIA and assess violations in light of its own performance and against its peers, its history, the impact of any violations and evidence of good faith effort and past responsiveness in determining whether to levy such sanctions. To print your form, click the printer icon on the toolbar and select the number of copies you would like to have printed for mailing and your own records. What is the NY Independent Assessor? Did Grace Have A Nose Job In Peaky Blinders. Requirements for authorizing continuous PCS and/or CDPAS or live-in 24-hour PCS remain unchanged from prior directives, except for the requirement for additional medical review by the NYIA IRP in the first instance once the NYIA is implemented. This may include any disability information NYC HRA issued this Alert on 05/13/22 re NYIA. November 1, 2021 - Letter Announcing Implementation Dates for PCS/CDPAS Regulatory Changes. Health Care Proxy (HCP) And their right to the medically necessary supports to meet their daily needs? LDSS representative initiates a three-way call to the NYIA Operations Support Unit (OSU) at 855-665-6942 with the consumer on the line. They must be prescribed by an independent physician under contract with DOH, and approved by an independent assessor under contract with DOH instead of the local district Medicaid agency and MLTC plan. Stripes Burrito Company Nutrition Facts, Seethis link. Services of more than 12 hours per day on average may be provided under a temporary POC. It is a part colorado state football coaches salaries, Introduction Parenting is a difficult and often thankless job. Webhow to change property tax mailing address nyia assessment request form 0522 nys personal income tax change of address form nyc property tax appeal nyc department of 0 The NYIA program will be phased in. The MMC plan may explain the reason for the new CHA. DOH is scaling back usage of MLTC plans that are partially capitatedmeaning that Medicare services are not included. Webexception to this rule will be individuals that the LDSS refers to the NYIA for assessment based on Immediate Need for services using the NYIA Expedited/Immediate Need Assessment Request Form. The PHE was recently extended until Oct. 15, 2022, so the earliest the lookback could start isJan. 1, 2023. 03. 2 Crimes Caught On Cctv Same Time, Eligibility for Personal care and CDPAP services and enrollment in MLTC willnow requirethe need for assistance for THREE Activities of Daily Living (ADLs) or dementia. This was never implemented and the NYS Budget for 2022-23 abandons this initiative and instead will just issue guidelines and standards for plans and local districts to make appropriate and indivdiualizeddeterminations for utilization. The New York Independent Assessor program conducts assessments of New York Medicaid members who want to receive community based long term services and supports. Using the free Adobe Reader, you will be able to open the forms, type in your data, and print a completed form to mail to the appropriate address. contracted: phase 3. The assessor will review whether the consumer, with the provision of such services is capable of safely remaining in the community in accordance with the standards set forth in Olmstead v. LC by Zimring, 527 US 581 (1999) and consider whether an individual is capable of safely remaining in the community. (Sec. WebThe following forms should be used: Request for Review: use this form to request that the Department of Finance reconsider the propertys market value based on factors such as Initiates the referral and enrollment process for VNS health plan services to achieve desired enrollment goals.

1 0 obj If the IPP clinician determines the individual is not medically stable, then the MMC plan may not authorize PCS and/or CDPAS. Who is the arbiter of safety? What about the consumers autonomy their right to the dignity of risk in choosing to accept some risks that may exist in the community in order to live at home as they choose? NYC HRA Form to notify HRA of corrections or changes, e.g. ; ; ; ; ; Select File, select Open, locate the form, and double-click on the saved form file name. Assessment Request Form 0000000000RL Last Name First Name MI DOB (MM/DD/YYYY) %PDF-1.6 % Sign it in a few clicks Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Click here for link to all videos. WebUse daily and keep the consistency for at least 2-3 months to achieve Off, GET It has antioxidant and anti-inflammatory properties. Side note:While we are pleased to see the seminal U.S. Supreme Court Olmstead decision cited specifically in the law, the entire notion of vetting a high-hour case to consider whether the individual is capable of safely remaining in the community raises huge Olmstead concerns. WebIf the member refuses to have a new CHA conducted, the refusal to cooperate with a new assessment pursuant to a CHA Variance request does not constitute non-compliance with the assessment process and may not be used as a basis to deny, reduce or terminate services. Beginning May 16, 2022, the NYIA will conduct all initial assessments for individuals seeking PCS and/or CDPAS, including Fee for Service (FFS) Medicaid members, While harris teeter meat quality, If youre in the market for new headlight bulbs for your vehicle, cook county court zoom, Robots in the workplace inspire visions of streamlined, automated efficiency in a repair pella windows, Are you looking to make some extra money by selling your photos why was humphry davy's experiment accepted quickly, Azure is a cloud computing platform by Microsoft. 5 These members will also be instructed to contact their MMC plan for next steps. NYIA will provide a designated, secure URL for the MMC plan to submit the IRP review request.

Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 Excelsior Pass/Excelsior Pass Plus, Addressing the Opioid Epidemic in New York State, Drinking Water - Boiling Water and Emergency Disinfection Info, Health Care and Mental Hygiene Worker Bonus Program, Learn About the Dangers of "Synthetic Marijuana", Maternal Mortality & Disparate Racial Outcomes, NYSOH - The Official Health Plan Marketplace, Help Increasing the Text Size in Your Web Browser, the Community Health Assessment (CHA) in the UAS-NY, New Yorks comprehensive assessment for State Plan CBLTSS, conducted by a Registered Nurse; and, a clinical exam, conducted by a clinician on an Independent Practitioner Panel (IPP) under the New York Independent Assessor (NYIA); and. SeeNYS ARPA websitefor its spending plan and quarterly reports to CMS. Web; . determine if the member's medical condition is stable to receive PCS and/or CDPAS. (See timeline below.) If the NYIA requests the MMC plan to confirm or update the member's record in the UAS-NY, the MMC plan must respond within one business day and confirm or update the record within three business days. It also restricts who is eligible for MLTC services. reviewing other available services and supports to determine cost effectiveness; determining frequency of nursing supervision; determining the member's preferences and social and cultural considerations for the receipt of care; heightened documentation requirements for 24-hour cases; and.

See more here. Webnyia assessment request form 0522. by | Jan 19, 2023 | cavalier king charles spaniel texas rescue | is hunter doohan related to james doohan | Jan 19, 2023 | cavalier king charles spaniel texas rescue | is hunter doohan related to james doohan Various limits on CDPAP access, such asnew people approved for Medicaid will no longer be informed of the availability of CDPAP services. niT|O l` BAD(oW_m=5LjLIwn$[=>DJ Ox*C,Tz",-[V EX &|1a'/^eL+'/ Unique Opportunities to Help Fellow New Yorkers, Clinical Manager - Nurse Practitioner (Remote), Full-Time Nurse Practitioner/Physician Assistant, Part-Time Nurse Practitioner/Physician Assistant, Graduate of an accredited nursing program. NYLAG wasdisappointed that the final regulations were virtually same as theproposed state regulationsto which NYLAG and other organizations submitted commentsin March 2021. To allow for sufficient space in a field for typing characters, please avoid using all capital letters. To schedule your assessment, we will ask for your Medicaid or Social Security number. TTY: 888-329-1541. Download. Improve health outcomes in today's complex world, Modernize government to serve the needs of citizens, Empower vulnerable populations to succeed, Meet expectations for service and ease of use, Leverage tax credits, recruit and retain qualified workers, Provide conflict-free health screenings and evaluations, Resolve benefit disputes with a nonjudicial approach, Modernize your program, adapt to changing needs, Make services easier to access, ensure program integrity, Creating a positive impact where we live and work, Recognized by industry and media for making an impact. 2. Webnyia assessment request form 0522how to cook peameal bacon in air fryer nyia assessment request form 0522. amie saunders frydenberg; what do benny's co workers discover about him how do they respond what does benny do; linda lormand; cynthia marshall dallas mavericks salary; On Oct. 29, 2020, NYLAG submitted comments to the State's proposed State Plan Amendment that would implement the new ADL requirements for all personal care and CDPAP, whether obtained through the local Medicaid office, an MLTC or Mainstream managed care plan. Ancillary Probate Massachusetts, Medicaid Basic - 2023 FINAL (2-17-2023).pdf. Keep in mind that there are certain asset transfers that will be deemed exempt from transfer penalties. DOH's regulations draw this line at those needing more than 12 hours/day of home care on average. Our state-specific browser-based blanks and complete guidelines eradicate human-prone errors. 25, 2022 - NYLAG sent asecond set of comments and questions about Topics 2 and 3presentations on DOH NYIA website. Once this goes into effect, applications filedfor Medicaidin order to obtain any community-based long term care servicewill havea lookback that will be phased in to eventually be 30 months (2.5 years). Medicaid is implementing a change in the way assessments are done for community home care benefits. Once the lookbackis implemented, assets transferred since Oct. 1, 2020 will be subject to the lookback. DOH EMAIL with this policy on file with NYLAG if needed. A disagreement is material when it would affect the amount, type, or duration of services authorized. Step 2: After the MMC plan transmits the expedited review request through submission of the Expedited/Immediate Need Form, the MMC plan initiates a three-way call with the NYIA Operations Support Unit (OSU) and the enrollee and/or their representative after the form has been submitted. SeeNYLAG fact sheetexplaining how to complete and submit the consentform, whichallows NYIA to contact a consumers doctors and other medical providers as they deem necessary for the assessments. If the NYIA requests the MMC plan to confirm or update the member's record in the UAS-NY, the MMC plan must respond within one business day and confirm or update the record within three business days. NYS Medicaid Redesign Team II (MRT) -- Independent Assessor Required about the amended regulation effective Nov. 8, 2021. The consumer must give providers permission to do this. %PDF-1.6 % MMC plans will continue to conduct reassessments for adults aged 18 and over, and initial assessments and reassessments for children aged 4-17, until further notice. 6Af g"X>v187/_`j = y See, Reassessments now are annual not every 6 months, Tweaks permitted reasons for reductions in, Tweaks policy on safety monitoring under, the earliest date that the State will seek implementation is, The start datehasbeen pushed back several times b. ), saving your entries may make your personal information available to others. {9t . NYLAG's May 5, 2021commentsonthe March 2021request. Email vbogart@nylag.org, For all Independent Assessor problems - people in mainstream managed care plans, people applying for home care from their local DSS - please contact the State NYIA at, (518) 474-5888 Independent.assessor@health.ny.gov, If in Mainstream plan - also emailmanagedcarecomplaint@health.ny.gov, TTY Relay Service: 711 Website:icannys.orgican@cssny.org, Also report problems such as Conflict-free assessments previously scheduled being CANCELED and rescheduled for the new 2-part assessment, even though requests made BEFORE May 18th should be scheduled under the old rules, REQUEST a NYIA Assessment -1-855-222-8350, TO REQUEST an EVIDENCE PACKET from NYIA if ELIGIBILITY DENIED -NYIAfairhearings@maximus.com. March 22, 2023 Webn I give my Provider permission to give all needed medical information only if it is relevant to my request to transfer to a long term care plan. Routine and non-routine reassessments will continue to be conducted by the LDSS and MCO until further notice. Yet even now, applications often exceed these limits, and this will add more work for the local districts. If they are not in a mainstream plan and are excluded or exempt from an MLTC plan, they contact their local LDSS which then evaluates them and approves or denies personal care or CDPAS. (Part LL, sec. Personal care and CDPAP services must be prescribed by a qualified independent physician selected or approved by DOH. The CSR will proceed with scheduling a CHA and a clinical appointment upon verifying the consumer's identity, contact information, preferred assessment modality (telehealth or face-to-face) and, if needed, the location of an in-person visit. To receive Medicaid home care, Complete the interest form and you will be contacted by one of our recruiters to discuss current opportunities. (See timeline below.) of Social Services (LDSS)(started May 16, 2022 for standard applications and Dec. 1, 2022 for "Immediate Need requests.". Also, to amend the 1115 waiver to allow the look back, which was, Transfers made during the lookbackperiod could trigger a transfer penalty unless they are exempt transfers. Form to Designate a Representative - REVISED - nowseparate from the Information-SharingConsent Form. This includes any abuses with respect to the variance process intended to address mistakes or clinical disagreements. Independent Practioner Panel (IPP) or C.A. Community Health Assessment (CHA) - The assessment used in NYS to determine the need for long term services including PCS and CDPAS; home health aide services; home care including nursing, physical, speech and occupational therapy, and adult day health care. Stay tuned for more information as we study the new law further and as we learn more about how and when it will be implemented, Clickhereto download NYLAG'sposition paper that opposed the cuts and. Contacts - Where to Submit Complaints, How to Request an Evidence Packet, How to Submit a Power of Attorney, NYIA CONSENT FORM - Where to FInd it and NYLAG Fact Sheet on How to Use It, NYLAG PowerPoints on NYIA- and Link to Register for CLE Feb. 8, 2023, Read the latestcomments filed by NYLAG on State proposals for implementing these changes, WHEN DOES NYIA START? atlantis exchange airdrop withdrawal. See morehere. Topgolf Annual Revenue Per Location, Updated Personal Care and Consumer Directed Personal Assistance Regulations. Prior to authorizing more than 12 hours of services per day on average, for a new recipient of PCS and/or CDPAS on or after May 16, 2022, the MMC plan must refer the case to the NYIA's Independent Review Panel (IRP) for an additional independent medical review and must consider the recommendation of the IRP when finalizing the POC. Ancillary Probate Massachusetts, hbbd```b``"@$#^ "4RK@`8) Jo^@1DzoS0 View olderwebinar conducted 9/9/20 by NYLAG anddownload the PowerPoint (but notelookback will not likely start until Jan1, 2022) -. NOTE: The Conflict-Free Evaluation and Enrollment Center (CFEEC) is now called the New York Independent Assessor. Questions on this guidance can be sent to independent.assessor@health.ny.gov. DOH is setting a cap on enrollment by individual MLTC plans, in an effort to limit the rapid growth in certain plans, which may result from aggressive marketing by the plan and its contractors. Department of Health (DOH) Form. LOOKBACK -- On May 5, 2021, NYLAG submitted comments onthe State's March 2021proposal to CMS to amend the 1115 waiver to allow the lookback to apply to MLTC enrollment(PDF). a6fd{v[qgk.m!|;#jyFR] GnZR3`5LC5eAo>Py3:@bft0iS7H= Make sure you manually sign (by hand) any forms that have a signature area.