| Covid-19 | Jun 23, 2020

Section 1135 Waiver Flexibilities-Coronavirus Disease 2019: New York

CMS approved a COVID-19 Section 1135 waiver request for New York, all related to Medicaid managed care. The waivers:- Extend by up to 180 days the deadline for an MCO to reach a service authorization decision (for both standard and expedited requests) if the delay is in the enrollee’s interest (under current rules, the maximum extension is 14 days).- Extend by up to 120 days the timeframe for a managed care enrollee to request an internal MCO appeal following receipt of the adverse benefit determination (under current rules, the request must be filed within 60 days).- Extend by up to 30 days the timeframe for the MCO to resolve a standard appeal as long as the delay is in the enrollee’s interest (under current rules, standard—i.e., non-expedited—appeals must be resolved within 14 days).All three waivers are conditioned on the following: – The MCO must pay for the service until the extended timeline expires, and – Even if the enrollee’s appeal is ultimately unsuccessful, the enrollee is not liable for repaying the costs of services that were paid for in the interim