Senior Health Partners
Member Handbook
This handbook will tell you how to use your Healthfirst plan. Keep this handbook where you can find it when you need it.
SHP21_03 1562-20 NYSDOH Approved 01/15/2021 Senior Health Partners Member Services
If you need help, you can call, or write to us Special services are available for people with at the address below. special needs. If you have special needs, call us and we will help you find services Senior Health Partners (and providers) that will fit your needs. We also 100 Church Street, 17th Floor can provide materials in large print if you ask us. New York, NY 10007 We can help you get VCO (Voice Carry-Over) 1-800-633-9717 or TTY (Text Telephone Device) by dialing 1-888-542-3821 (English); 1-888-867-4132 Call if you need to talk to your Care Team, (Spanish) to help make communication easier. ask about benefits, get referrals, replace your This member handbook is also available in large Member ID card, change or pick a provider. print/CD if you ask us. Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Coverage for Senior Health Partners, Managed Long-Term Care Plan, is provided by Healthfirst PHSP, Inc. Plans contain exclusions and limitations.
The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide Participants/Members free, confidential assistance on any services offered by Healthfirst Health Plan, Inc. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org. (TTY users call 711, then follow the prompts to dial 1-844-614-8800.)
I Senior Health Partners Member Handbook Notice of Non-Discrimination
Healthfirst complies with Federal civil rights laws. Healthfirst does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Healthfirst provides the following: Free aids and services to people with disabilities to help you communicate with us, such as: – Qualified sign language interpreters – Written information in other formats (large print, audio, accessible electronic formats, other formats) Free language services to people whose first language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, call Healthfirst at 1-866-305-0408. For TTY services, call 1-888-542-3821. If you believe that Healthfirst has not given you these services or treated you differently because of race, color, national origin, age, disability, or sex, you can file a grievance with Healthfirst by: Mail: Healthfirst Member Services, P.O. Box 5165, New York, NY, 10274-5165 Phone: 1-866-305-0408 (for TTY services, call 1-888-542-3821) Fax: 1-212-801-3250 In person: 100 Church Street, New York, NY 10007 Email: http://healthfirst.org/members/contact/ You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by: Web: Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Mail: U.S. Department of Health and Human Services 200 Independence Avenue SW., Room 509F, HHH Building Washington, DC 20201 Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html Phone: 1-800-368-1019 (TTY 800-537-7697)
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year II © 2018 HF Management Services, LLC 1523-18
III Senior Health Partners Member Handbook Important Senior Health Partners Phone Numbers
IMPORTANT SENIOR HEALTH PARTNERS PHONE NUMBERS
Care Team 1-800-633-9717
Quality Management Department 1-800-633-9717
Enrollment Unit 1-866-585-9280
Transportation 1-866-202-3874
OTHER IMPORTANT PHONE NUMBERS
Independent Consumer Advocacy 1-844-614-8800 Network (ICAN)
New York Medicaid Choice 1-888-401-6582
New York State Department of Health 1-866-712-7197
NYC Human Resources Administration 1-718-557-1399
Nassau *NY Connects 1-516-227-8900
Westchester Local Dept. Social Services *1-914-995-5000
*General Information for City Offices number
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year IV Important Names and Phone Numbers
Name Phone Number/Address
Care Manager
Names, Addresses, and Phone Numbers of Providers
Your Senior Health Partners Office Address
In an emergency, call 911 immediately. Call Senior Health Partners within 24 hours.
V Senior Health Partners Member Handbook V About this Member Handbook
This handbook is given to you to help you learn Membership Card about the plan. Please read it and use it when you Your Senior Health Partners identification need information about how the plan works. card (Member ID card) will be mailed to For example: you. Carry this card with you at all times. ¡ When you want to know what services You need to show it to your provider. are covered and how to get them. ¡ What to do in an emergency. ¡ What to do when you are unhappy with services. ¡ When you need to make decisions about your healthcare.
If you enroll in Senior Health Partners, this handbook is your guide to services and your contract (along with your enrollment agreement). If you lose the directory, you can ask for one by calling 1-800-633-9717 (TTY 1-888-542-3821 for English; 1-888-867-4132 for Spanish), 24 hours a day, 7 days a week. You will get the participating Provider Directory in the mail. You can also access the Provider Directory online by visiting https:// healthfirst.org/senior-health-partners-plan.
To be a Senior Health Partners member, you have to be eligible for Medicaid or be able to pay for services yourself (this is called private pay). If you pay yourself, read the Private Pay section at the end of this handbook.
Tips for New Members ¡ Keep your handbook within easy reach. ¡ Keep your Member ID card in your wallet with your Medicaid and Medicare cards. ¡ Make sure you have the Senior Health Partners telephone numbers near your telephone. ¡ To help you work with your personal care aide, we included a guide in your welcome kit. It gives you examples of what your aide can and cannot do. It also gives you a place to write down information about your home care routine.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year VI VI TABLE OF CONTENTS
Notice of Non-Discrimination ...... II Important Names and Phone Numbers ..V Language Assistance Information ...... III About This Member Handbook ...... VI Important Senior Health Partners Membership Card ...... VI Phone Numbers ...... IV Tips for New Members ...... VI
Welcome to Senior Health Partners ...... 3 Getting Care/Care Management ...... 10 What is Managed Long-Term Care? ...... 3 Who is part of my Senior Health Partners Care Team? ...... 10 Your Rights and Responsibilities as a Senior Health Partners Member ...... 3 How will joining Senior Health Partners change how I access my healthcare? ....11 What are my Rights and Responsibilities as a Senior Health Partners Member?.....3 Primary Care Providers and Other Non-Covered Service Providers ...... 11 Your Right to Use an Advance Directive ...4 Where You Will Get Services ...... 11 What if your instructions are not followed? ...... 4 Participating Providers and Covered Services ...... 11 Responsibilities of Members ...... 5 Access to Care ...... 11 Monthly Surplus ...... 5 Covered Services ...... 12 Notice of Information Available on Request ...... 6 Nursing Home Care ...... 16 Eligibility and Enrollment ...... 6 Services for Veterans ...... 16 What are the advantages of enrolling Money Follows the Person (MFP)/ in Senior Health Partners? ...... 6 Open Doors ...... 16 Who is eligible to enroll in Non-Covered Services...... 17 Senior Health Partners? ...... 6 How to Obtain Covered Services ...... 18 Conditions for Denial of Enrollment .....7 Authorization for Services ...... 19 Private Pay ...... 7 Requesting Additional Services or What is the enrollment process Changes to the Person-Centered for Senior Health Partners? ...... 8 Service Plan (PCSP) ...... 19 Withdrawal of Enrollment ...... 9 Emergency Services ...... 19 If you want to transfer to another MLTC Care Received Outside the Senior Health Medicaid Plan ...... 10 Partners Service Area ...... 19 Transitional and Specialty Care ...... 20
1 Senior Health Partners Member Handbook TABLE OF CONTENTS (continued)
Disenrollment, Termination of Benefits, What is an Action? ...... 25 and Voluntary Disenrollment ...... 20 Timing of Notice of Action ...... 25 Voluntary Disenrollment ...... 20 How Do I File an Appeal of Involuntary Disenrollment ...... 21 an Action? ...... 25 Effective Date of Disenrollment How Do I Contact My Plan and Coordination of Transfer to to File an Appeal ...... 25 Other Service Providers ...... 22 For Some Actions You May Re-Enrollment Provisions ...... 22 Request to Continue Service During the Appeal Process ...... 26 Complaints and Complaint Appeals Process ...... 22 How Long Will it Take the Plan to Decide My Appeal of an Action? .....26 What is a Complaint?...... 22 Expedited Appeal Process ...... 26 The Complaint Process ...... 23 If the Plan Denies My Appeal, How do I Appeal a Complaint What Can I Do? ...... 26 Decision? ...... 23 State Fair Hearings ...... 27 Service Authorizations, Actions, and Action Appeals ...... 23 State External Appeals ...... 27 Prior Authorization ...... 23 Contacting the New York State Department of Health ...... 28 Concurrent Review ...... 23 Quality Assurance and Retrospective Review...... 23 Improvement Program ...... 28 What Happens After We Get Your Service Authorization Request? ...... 23 Timeframes for Prior Authorization Requests ...... 24 Timeframes for Concurrent Review Requests ...... 24 If we need more information to make a decision ...... 24 If our Answer is Yes to Part or All of What You Asked For ...... 24 If our Answer is No to Part or All of What You Asked For ...... 24
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 2 Welcome to Your Rights and Senior Health Partners Responsibilities as Thank you for choosing Senior Health Partners a Senior Health for your managed long-term care. We want to be sure you get off to a good start as a new member. Partners Member This handbook will help you understand your health benefits. What are my Rights and Senior Health Partners is a Healthfirst plan. Responsibilities as a Senior Healthfirst is New York’s largest not-for-profit Health Partners Member? health insurer. We have been offering affordable plans to New Yorkers for more than 25 years. As a Senior Health Partners member, you have As a Senior Health Partners member, you will get the right to: services from providers who are in-network. n receive medically necessary care. The plan and your providers will help you stay in your home for as long as possible. You will get n receive care and services at the time you the participating Provider Directory in the mail. need them. You can also access the directory online at healthfirst.org/senior-health-partners-plan. n ask for an increase in your services, including, but not limited to, your home care services.
What is Managed n privacy about your medical records.
Long-Term Care? n receive information on available treatment options and alternatives, given to you in The goal of managed long-term care is to help a specific way (if you ask for it) and in you stay in your home or community for as a language you understand. long as possible. The plan gives you the care and support you need, so you can handle daily n receive oral translation services free of charge activities that you cannot do without help. It gives to get information in a language you you helpful medical, personal, and social services understand. you may need. You will be assigned a Care Management Team that will get to know you. n receive all information you need to give us The team will help you find providers in your area, approval before the start of any treatment. and services and supports to help you meet n your needs. receive a copy of your medical records and ask that the records be changed or corrected. A home health aide or personal care aide may be n assigned to help you with activities of daily living make decisions about your healthcare, (ADL). These are things like: including the right to refuse treatment. n to be treated with respect and due n eating consideration for your dignity. n going to the bathroom n make decisions about your healthcare, n getting out of bed including the right to refuse treatment.
n bathing n to be free from any form of restraint or seclusion used as a means of coercion, n dressing discipline, convenience, or retaliation.
Our goal is to help you stay as independent n to get care without regard to sex, (including as possible. gender identity and status of being transgender), race, health status, color, age, national origin, sexual orientation, marital status or religion.
3 Senior Health Partners Member Handbook n be told where, when, and how to get the n Get the form. If you want to have an services you need from your managed advance directive, you can get a form from long-term care plan (this includes how your lawyer, a social worker, an office supply you can get covered benefits from out-of store or other available resources. You can network providers if they are not available also call Healthfirst Member Services to get in the plan network). the forms (phone numbers are printed on the back of this booklet). n complain to the New York State Department of Health or your Local n Fill it out and sign it. Before you fill it out, Department of Social Services; and the think about having a lawyer help you. Right to use the New York State Fair This is a legal document about your Hearing System and/or a New York State healthcare services. Be sure to sign it when External Appeal, where appropriate. you are done.
n receive help from the Independent Consumer n Give copies to the right people. You should Advocacy Network (ICAN) (also known as give a copy to your provider and to the a Participant Ombudsman program). person who will make decisions for you, before you are no longer able to make n name someone to speak for you about your healthcare decisions for yourself. You may healthcare and treatment. want to give copies to close friends or n give instructions about what is to be done if family members. Be sure to keep a copy for you are not able to make medical decisions yourself and put it in a safe place. for yourself. If you know that you are going to be n participate in the six-month assessment hospitalized, and you have signed an advance visit or sooner as needed directive, bring a copy with you to the hospital. n n review your care needs with your care team If you are admitted to the hospital, they will during the monthly call ask you if you have a signed advance directive form and if you have it with you.
Your Right to Use an n If you do not have a signed advance directive form, the hospital has forms Advance Directive available. You can fill one out, and also sign If you are unable to make healthcare decisions it there if you want to. for yourself (due to an accident, serious illness, It is your choice if you want to fill out an or other issue), you have the right to say what advance directive (including if you want to sign you want to happen. This means you can: one if you are in the hospital). As stated by the n fill out a written form to give someone the law, no one can deny you care or discriminate legal authority to make medical decisions against you if you have or don’t have a signed for you. advance directive. n give your providers written instructions What if your instructions are about how you want them to handle your medical care. not followed? If you have a signed advance directive, and you The legal documents that you can use to give believe that a provider or hospital did not follow your directions in advance of these situations the instructions on it, you can call Senior Health are called “advance directives.” There are Partners Member Services at 1-800-633-9717. different types and different names for them. For TTY services, call 1-888-542-3821. You can Documents called “healthcare proxy form,” and also write to: “power of attorney for healthcare” are examples of advance directives. If you want to use an Senior Health Partners Plan “advance directive” (to give instructions about Attn: Appeals and Complaints your care), here is what to do. P.O. Box 5166 New York, NY 10274-5166
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 4 At Senior Health Partners, we must obey Acknowledgement of the Roles and New York State Law on advanced directives. Responsibilities for Receiving CDPAS” Our team knows the law, and educates the document (when you get it). community. We will keep your advance directive information as part of your records. 2. Support Senior Health Partners by: By law, you must write down your healthcare n giving us your opinions, concerns, and wishes (if you can’t make a decision for suggestions through your Care Team, or yourself), sign an advance directive form, and through the Senior Health Partners have an adult witness it. You can change your Grievance and Appeals Process. mind about your healthcare proxy (this is the person you assign to make healthcare decisions n reading the handbook and following for you) or your advance directives at any time. procedures to get healthcare services. Just fill out new forms, sign them, and have them witnessed. n respecting the rights and safety of all those involved in your care and helping Senior Responsibilities of Members Health Partners to make your home safe. n telling your Care Team any of these: To get the greatest benefit from enrollment in Senior Health Partners, you have these ➤ if you are leaving the service area responsibilities: ➤ if you have moved or have a new 1. Participate in Making Your Healthcare telephone number Decisions by: ➤ if you have changed providers n talking openly and honestly with your provider and Care Team about your care. ➤ any changes in condition that may affect our ability to give you care n asking questions to be sure you understand your Person Centered Service Plan (PCSP) and knowing what will happen if you do Monthly Surplus not follow your PCSP. Your PCSP and The fee that you will pay to Senior Health changes to your PCSP will be discussed Partners depends on your Medicaid eligibility and and documented as part of our monthly its monthly surplus program. This section does care management call. not apply to private pay members. See Private Pay Section. n partnering in care decisions and being in charge of your own health. If you are n You will pay: completing self-care as planned. eligible for: n keeping appointments or telling the Care Team if you need to change Medicaid (no monthly Nothing to Senior an appointment. spend down/NAMI) Health Partners
n using the Senior Health Partners network Medicaid (with A monthly surplus to providers for care (except in emergency monthly spend down/ Senior Health Partners, situations). NAMI) as determined by New York City HRA n telling Senior Health Partners that you or LDSS. got healthcare services from other healthcare providers. If you are eligible for Medicaid with a surplus n helping us with policy development by and your surplus changes while you are a Senior writing to us, calling us, or being part of Health Partners member, your monthly payment the member advisory council. will be adjusted.
n reading and signing the “Consumer/ If you don’t pay (or prepare to pay) the Medicaid Designated Representative surplus within 30 (thirty) days after the first
5 Senior Health Partners Member Handbook amount is due (even though we gave you a written n written application, procedures, and minimum notice for payment and told you in writing that you qualification requirements for healthcare may be disenrolled), we can disenroll you. providers to be considered by Senior Health Partners
Notice of Information Available n information concerning the education, facility on Request affiliation, and participation in clinical performance reviews made by the Department The below is available to you if you ask for it: of Health, of healthcare professionals who are licensed, registered, or certified under Article 8 n a list of names, business addresses, and official of the State Education Law positions of the members of Healthfirst’s Board of Directors, officers, controlling partners, and owners or partners Eligibility and Enrollment n a copy of the most recent annual certified financial statement of Healthfirst, including What are the advantages of a balance sheet and summary of receipts enrolling in Senior Health and disbursements prepared by a certified public accountant Partners?
n information related to member complaints The decision to join Senior Health Partners is and aggregated information about grievances important. It affects how you get the healthcare and appeals services you need on a regular basis. If you choose Senior Health Partners, you agree to get services n Senior Health Partners’ procedures for only from Senior Health Partners and its network protecting confidentiality of medical records of providers, as described in your Person Centered and other member information Service Plan (PCSP).
n a written description of the organizational As a member, you will have a Care Team. You will be arrangement and ongoing procedures of Senior assigned a Care Manager who knows how to care Health Partners’ Quality Assurance Program for people with long-term-care needs. This person will help you learn what services are available to you n a description of the procedures followed by and how to use your Medicaid benefits. Senior Health Partners in making decisions about the experimental or investigational Some benefits to being a member: nature of individual drugs, medical devices, or treatments in clinical trials n You get a personal Care Team who will get to know you personally. n Upon written request, specific clinical information relating to a certain condition or n Your Care Team will manage your care at disease, or other clinical information which home, in a hospital, or in a nursing home. Senior Health partners might consider in its n Your family and home caregivers will help you utilization review, and how it is used in the stay in your own home. utilization review process. However, when information is specific to Senior Health n You are enrolled until you decide to disenroll. Partners, the member/future member will only use it to help the member/future member n You can get help with Medicaid recertification. check the covered services given by Senior Health Partners. Who is eligible to enroll in n individual health practitioner affiliations with Senior Health Partners? participating hospitals and other facilities You may be eligible to enroll in Senior Health n licensure, certification, and accreditation Partners if you are: status of participating providers n at least 18 years of age or older.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 6 n Living in Manhattan, the Bronx, Brooklyn, Conditions for Denial of Queens, Staten Island or Nassau or Westchester counties. Enrollment n qualified for Medicaid or agree to pay a You will be denied enrollment if any of private pay premium for care (as described in these apply: Enrollment, and Private Pay Sections). Private Pay does not apply to Staten Island, or to n You did not meet one of the eligibility Nassau or Westchester counties. requirements. n in need of community-based long-term care n You were previously a member of Senior services (CBLTCS)* covered by Senior Health Health Partners and do not meet our Partners for a continuous period of more requirements for re-enrollment. than 120 (one hundred twenty) days from See Re-enrollment Provisions Section. the date of enrollment. n Senior Health Partners has reached the most n you must need at least one of the number of private pay members that may be services below. enrolled (according to New York State). ➤ Nursing services in the home Following a Conflict-Free Evaluation and ➤ Therapies in the home Enrollment Center (CFEEC) evaluation (see ➤ Home Health Aide services next section), you will get a notice about your ➤ Personal Care services in the home eligibility for CBLTCS. If you are not eligible, you will get a notice saying you can have a Fair ➤ Adult Day Health Care Hearing (except for private pay members) to talk ➤ Private Duty Nursing about eligibility. See PrivatePay Section. ➤ Consumer Directed Personal Assistance Services (CDPAS) Private Pay *CBLTCS are healthcare and supportive services You may be able to enroll in Senior Health for people of all ages with functional limitations Partners even if you are not eligible for Medicaid. or chronic illnesses. These services are help If you agree to pay the full premium for with daily activities such as bathing, dressing, coverage, and Senior Health Partners has not preparing meals, and taking medications. CBLTCS reached its enrollment limit for private pay will give members Home Health Services, Private enrollees, you may be able to enroll. Private Duty Nursing, Consumer Directed Personal Pay does not apply to Staten Island, Nassau or Assistance Services, Adult Day Health Care Westchester counties. Programs, and Personal Care Services. The private pay member premium is equal to If you qualify for Senior Health Partners, you the amount of the Medicaid rate as approved must sign an Enrollment Agreement Attestation for Senior Health Partners by the New York State and agree to follow the rules of Senior Health Department of Financial Services. You must pay Partners. this amount on the first day of the first full month Enrollment is subject to approval by New York that services are given by Senior Health Partners. Medicaid Choice (NYMC) or LDSS or place You will have a one-month grace period if your chosen by the New York State Department of premium is overdue. Senior Health Partners will Health, except for private pay. See Private send you a letter advising you of the late payment Pay Section. and inform you that termination can and will result for non-payment of services. You will continue to get benefits during this grace period. If your payment is not received, your enrollment will be terminated, and you must pay for the services that you got during the grace period. A written notice of termination will be provided to you. Your premium cannot be pro-rated and is not refundable.
7 Senior Health Partners Member Handbook Monthly payment to Senior Health Partners What is the enrollment process remains the same even if you experience changes in your health. Premium payments may for Senior Health Partners? be made by check or money order to: Step 1: Confirm eligibility for Senior Health Partners P.O. Box 48344 long-term care services Newark, NJ 07101-4844 If you have not received MLTC services You should not cancel a Medicare supplemental before, you will receive an evaluation from the policy if you have one, since you will be Conflict-Free Evaluation and Enrollment Center responsible for some Medicare copays and (CFEEC). CFEEC is an entity, New York Medicaid deductibles even after you enroll in Senior Choice (NYMC), that contracts with New Health Partners. Unless already covered by a York State Department of Health (NYSDOH) Medicare supplemental policy, the premium to provide initial evaluations of applicants to you pay to Senior Health Partners covers determine eligibility for community-based Medicare nursing home copays for days 21 to long-term care. They help educate new 100, durable medical equipment copays, and applicants. This evaluation is not required for any Medicare copay or deductible applicable applicants transferring from one MLTC plan to to a covered benefit. However, payment of the another except for non-dual applicants coming private pay premium to Senior Health Partners from Medicaid Managed Care. All applicants will not free you of your responsibility for any that are new to community-based long-term Medicare copays or deductibles for non-covered care services or have not had community- benefits. For example, private pay members are based long-term care services for more than 45 responsible for the hospital deductibles and (forty-five) days must have a CFEEC evaluation provider copays. and can call the CFEEC at 1-855-222-8350, Monday to Friday, 8:30am–8pm, or Saturday, Non-covered services (see Benefits and 10am–6pm, to schedule an appointment. Coverage/Coordination of Other Medical Services Section) must be paid by a private Once New York Medicaid Choice decides if a pay member. person is eligible for CBLTCS (for a continuous period of more than 120 (one hundred twenty) The services in this handbook also apply to days), the person can choose an MLTC plan. private pay members. However, exceptions The CFEEC review is only good for include, but are not limited to: 75 (seventy-five) days. After this, a new evaluation has to be done if the person does n NYC HRA/LDSS enrollment and not pick a plan and still wants CBLTCS. disenrollment at the same time is not required. Step 2: Confirm Eligibility for Medicaid n New York State Medicaid Fair Hearing Enrolling in Senior Health Partners is voluntary. cannot be requested. If you want to join, you (or someone on your These also apply to private pay members: behalf) can call Senior Health Partners. Our team will help you contact New York Medicaid n New York State External Appeals process Choice to find out more about Senior Health Partners. If you qualify and have a completed n Senior Health Partners Internal Grievance New York Medicaid Choice review (if required), and Appeal process (see Complaints and a Healthfirst employee will check your Appeals Process Section) Medicaid eligibility.
n Private Pay enrollees must sign a Private Pay n Your Medicaid eligibility must be reviewed enrollment attestation/agreement and approved by the NYC Human Resources Administration or Local Department of Social Services.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 8 n If you do not currently have Medicaid, we Step 4: Sign Enrollment Agreement will help you apply for Medicaid coverage. n After the initial assessment, our nurse will If you are not eligible for Medicaid, you can ask you to sign the Enrollment Agreement still join Senior Health Partners. But, you must Attestation. Private pay enrollees will sign pay privately, and Senior Health Partners may an Enrollment Agreement for Private Pay not be over its enrollment limit (for private pay Participants. See Private Pay Section. By enrollees). If you want to pay privately, see signing the Enrollment Agreement Transfer Private Pay Section. Attestation, you agree to:
Step 3: Nurse Assessment ➤ the initial PCSP offered by Senior Health Partners After confirming eligibility, we will give you ➤ get all covered services from Senior a call to provide you with more information Health Partners and our network about the plan and will schedule a telephonic providers. or home assessment for one of our registered nurses to assess your clinical eligibility for the ➤ participate in Senior Health Partners plan. We will also ask you for information about according to the terms and conditions your healthcare needs. described in this handbook.
n Our Clinical Eligibility Nurse will ask you for n Before your enrollment date, we may verbal consent to let him/her assess your contact you to answer questions or get healthcare needs and clinical eligibility. more information. You should respond as soon as you can, so you can get enrolled ➤ Our nurse will ask you to provide verbal as soon as possible. After this, you will get consent that lets your healthcare your membership letter and a Senior Health providers give us your medical Partners Member ID card. information, where applicable. n Your enrollment effective date will start on n Our Clinical Eligibility Nurse will conduct the first of the month following the a telephonic or home assessment within successful completion of your application. 30 (thirty) days after you ask to join Senior After this, your Care Team will call you to Health Partners, or from CFEEC’s referral, to: further discuss your first PCSP and answer ➤ identify your healthcare needs (also any questions you have. Your Care Team will called an “initial assessment”). also ask you, your provider, and your family/ caregivers to help with any future changes ➤ find out if you are eligible for nursing in your PCSP. home level of care, as required for enrollment (if you have Medicaid only Withdrawal of Enrollment or have Medicare and Medicaid and are age 18–20). You can ask Senior Health Partners verbally or in writing to withdraw your application or enrollment ➤ find out if you require community-based agreement by noon (12pm) on the 20th day of the long-term care services offered by month before your enrollment date. Senior Health Partners for a continuous period of more than 120 (one hundred If your request is received after this, you will be twenty) days. disenrolled from Senior Health Partners on the first of the next month. You may also contact ➤ provide you with information and mail New York State Medicaid Choice directly you a Health Care Proxy form (if you to withdraw your application or enrollment want to assign someone you trust to agreement. make healthcare decisions for you).
➤ talk about services you may need.
9 Senior Health Partners Member Handbook If you want to transfer to another Getting Care/ MLTC Medicaid Plan Care Management You can try us for 90 (ninety) days. You may leave Senior Health Partners and join another health Who is part of my Senior Health plan at any time during that time. If you do not leave in the first 90 (ninety) days, you must stay in Partners Care Team? Senior Health Partners for nine (9) more months, After you enroll, you will be assigned a Primary unless you have a good reason (good cause). Some Care Manager (PCM). Your PCM is supported by examples of good cause include: specialty teams. This team will manage your chronic health problems. n You move out of our service area. With the help of specialty teams, your Care n You, the plan, and your county Department Team will check changes in your health, and of Social Services or the New York State coordinate care and services. The team can help Department of Health all agree that leaving you with any health issues you have. You can ask Senior Health Partners is best for you. to change any member of your Care Team at n Your current home care provider does not any time. work with our plan. Your Care Team will develop a Person Centered n We have not been able to provide services to Service Plan (PCSP) with you and any one you you as we are required to under our contract want to help you with your plan of care to meet with the State. your healthcare needs. The PCSP will include your goals, objectives, and special needs. Your If you qualify, you can change to another Care Team may contact your provider to talk type of managed long-term care plan like about and develop your PCSP. This plan will Medicaid Advantage Plus (MAP) or Programs of change as your needs change. It will be All-Inclusive Care for the Elderly (PACE) at any re-evaluated at least every 6 months, based time without good cause. To change plans: on the 6-month UAS assessment, but will Call New York Medicaid Choice at be reviewed and updated according to 1-800-505-5678. The New York Medicaid Choice your condition. See Care Planning and Care counselors can help you change health plans. Management Section. It could take between two (2) and six (6) weeks Your Care Team will work with you and for your enrollment into a new plan to become your provider to arrange appointments and active. You will get a notice from New York transportation, and talk to other care providers Medicaid Choice telling you the date you will be about services covered (and not covered) by enrolled in your new plan. Senior Health Partners Senior Health Partners. You will have an in-person will provide the care you need until then. assessment of all your care needs every 6 months, including an evaluation of your home to make Call New York Medicaid Choice if you need to it the most functional to support your activities ask for faster action because the time it takes to of daily living. By helping you manage all parts transfer plans will be harmful to your health. of your care, your Care Team can find problems You can also ask them for faster action if you have early, stop problems from getting worse, and told New York Medicaid Choice that you did not help you avoid trips to the hospital and agree to enroll in Senior Health Partners. emergency room.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 10 How will joining Senior Health Senior Health Partners at 1-800-633-9717 (for TTY services, call 1-888-542-3821). You can Partners change how I access choose any network provider from this list for my healthcare? covered services. Senior Health Partners will help you choose or change a provider for covered or non-covered services. Primary Care Providers and Other Non-Covered Service Providers You can switch to another network provider at any time. The provider will be changed as soon You can choose your own provider, as described as possible. If you have questions about the in this handbook. You can also change your qualifications of any provider, you can ask your provider at any time. Care Team. If you do not have a provider, your Care Team Network providers will be paid in full directly can help you find a provider. by Senior Health Partners for each service approved and given to you, with no copay or If you need help finding or changing your cost to you. You must pay the Medicaid Surplus provider, call a member of your Care Team at the (Spend down/NAMI), if you have one, to keep telephone number on your Member ID card. your Medicaid benefit. See Monthly Surplus You can choose any provider you want for section. Note: Medicaid Surplus does not apply services not covered by Senior Health Partners. to private pay members. Your Care Team will help you find providers for non-covered services if you do not have a If you get a bill for covered services approved provider. See Non-Covered Services Section. by Senior Health Partners, please call your Care Team. You may have to pay for services that Where You Will Get Services were not approved by Senior Health Partners. You may pay for covered services that were Most of your covered healthcare services are given by out-of-network providers and without given in your home or can be handled in the prior authorization. community within our provider network. You can use services in a medical office for Access to Care dental, podiatry, audiology, or optometry services. You may get inpatient nursing home Before you can get most covered services, services in one of our participating inpatient your Care Team must authorize the service. nursing home facilities. Some covered services require a provider’s order. However, your provider or your Care Participating Providers and Team does not have to authorize services for Covered Services you in an emergency or urgent situation. You can also go to the podiatrist, dentist, You can choose providers for covered services audiologist, and optometrist for tests and routine paid for by Medicare. Senior Health Partners services without prior authorization. See section pays the Medicare copays for covered services on Covered Services. if Medicare is the primary payer. However, when Medicare stops paying for these services, you must use a network provider in order for Senior Health Partners to cover the service. As a result, it may be better for you to choose one of our network providers right from the start. You can find our provider network online at HFDocFinder.org or request a print copy of our Provider Directory be sent to you by calling
11 Senior Health Partners Member Handbook Covered Services What are the benefits and services covered by Senior Health Partners? Senior Health Partners offers a wide range of home, community, and facility-based healthcare services and Long-Term Services and Supports. All of the services are provided by Senior Health Partners through our provider network and are fully covered in your Person-Centered Service Plan (PCSP). Only veterans may access Veteran’s Home Services. To find network providers in your neighborhood, please check the current Provider Directory. Your provider must get authorization from Senior Health Partners for services. These services require a prior authorization and will be authorized by Senior Health Partners if they are medically necessary.
Covered Services Provided as Medically Necessary are:
Covered Services Definition
Adult Day Health Care n Care and services given in a healthcare facility, which includes: medical, nursing, nutrition, social services, rehabilitation therapy, leisure time activities, dental, or other services.
Audiology and n Audiology services include examination, testing, hearing aid Hearing Aids evaluation, and prescription. n Hearing aid services include selecting, fitting, repairs, replacements, special fittings, and batteries.
Care Management n Care Management helps coordinate services that you find in the Person Centered Service Plan (PCSP). n Care Management services include referral, help in or management of services to get medical, social, educational, psychosocial, financial, and other services in support of the PCSP, regardless if services are in the Benefit Package.
Consumer Directed n This program lets you, or the person acting for you (also known as Personal Assistance the “consumer”), hire, train, supervise, arrange back-up coverage, Service (CDPAS) keep payroll records, and fire the person providing you with personal care services. You can ask to use the CDPAS program at any time. You can disenroll from the program at any time. Senior Health Partners will review the level of personal care services, home health aide services, and/or skilled nursing services you require, and write you a plan of care.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 12 Covered Services Definition
Consumer Directed n Once Senior Health Partners finds out your needs, creates your Personal Assistance plan of care, and tells you how many hours of services are Service (CDPAS) needed, the next step will be for you to find the sufficient number (continued) of personal assistants (PAs) needed to perform the services in your plan of care. A PA can be almost anyone you want - a family member, friend, neighbor, or former aide - but they must be trained to do the work you need. A PA cannot be your spouse or your designated representative. The consumer must work with the Senior Health Partners team to arrange covered services with providers or healthcare agencies. n As the manager of your care, the consumer is responsible for scheduling their PAs. They need to make sure that there is coverage if a PA cannot make it to work. The consumer also needs to keep track of their time worked and sign-off on time sheets and other important documents.
Dentistry n Includes, but is not limited to, routine exams, preventive, and therapeutic dental care, dental implants, dentures, and supplies.
Durable Medical n Medical/Surgical Supplies: Items for medical use (other than Equipment (DME) drugs) that treat a specific medical condition such as diabetes, wound dressings, and other prescribed therapeutic supplies. n Medical Equipment: Adaptive devices and equipment prescribed by a medical provider. n Enteral and Parenteral Nutritional Supplements: Liquid nutritional supplements as prescribed. Enteral formula limited to nasogastric, jejunostomy, or gastrostomy tube feeding; or treatment of an inborn error of metabolism. n Prosthetics: Artificial substitute or replacement of a limb. n Orthotics: Appliances and devices used to support or correct a movable part of the body. n Orthopedic Footwear: Shoes, shoe modifications, or shoe additions that are used to correct, help, or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot; to support a weak or deformed structure of the ankle or foot, or to form an integral part of a brace.
13 Senior Health Partners Member Handbook Covered Services Definition
Home Care n Nursing: On and off, part-time nursing services given by RNs and LPNs. Nursing services include care given directly to the individual and procedure instructions to the caregiver for treatment or maintenance. n Home Health Aide: Home Health Aide services may include vital signs, giving pre-drawn insulin, effortless motion exercises, housekeeping services. n Physical Therapy (PT): Exercise and physical activities used to work muscles and improve activity levels. A licensed physical therapist must follow the PT rules in your plan of care. n Occupational Therapy (OT): Therapy using specific daily living activities to help people with physical or mental limitations. A licensed physical therapist must follow the OT rules in your plan of care. n Speech Pathology (SP): Therapeutic treatment of speech impairments (such as lisping and stuttering) or speech difficulties that result from illness. A licensed speech language pathologist must follow the SP rules in your plan of care. n Medical Social Services: Help with getting and keeping benefits, so you can stay in the community.
Home Delivered or n Meals given to you at home or in another setting (for example, Congregate Meals an adult home) if you do not have cooking equipment or if you have a special need.
Non-emergent Medical n Travel by ambulance, ambulette, taxi, or livery service to medical Transportation care and services or public transportation at the appropriate level for your condition in order to obtain necessary medical care and services.
Nursing Home Care n Care by an in-network licensed facility (see Nursing Home Care section).
Nutritional Counseling n Provided by the Senior Health Partners Registered Dietician (RD) or Diet Technician (DT). The RD or DT work with you and the care team on your diet.
Optometry/Eyeglasses n Includes the services of an optometrist and an ophthalmic dispenser, eyeglasses, medically necessary contact lenses, and other low-vision aids. Eye exams are also covered to detect visual defects and eye disease. Exams that include refraction are limited to every two (2) years unless medically necessary. Routine vision services do not require authorization. Medically necessary services may require prior authorization.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 14 Covered Services Definition
Outpatient Rehabilitation n Physical Therapy (PT): Rehabilitative health that uses specific Therapies exercises and equipment to help patients get back or improve their physical abilities. n Occupational Therapy (OT): Rehabilitative health that uses specific exercises and equipment to help patients get back or improve their abilities to perform daily activities of living. n Speech Pathology (SP): Rehabilitation services to get back your functional level of speech or language. To learn more about these services, call Member Services at 1-800-633-9717 (TTY 1-888-542-3821).
Personal Care n Help with one or more activities of daily living, such as walking, cooking, cleaning, bathing, using the bathroom, personal hygiene, dressing, feeding, nutritional and environment support function tasks.
Personal Emergency n An electronic device that sends a signal to a medical response Response System center when you are having a physical, emotional, or environmental emergency.
Podiatry n Routine foot care to help with localized illness, injury, or symptoms involving the foot; or for medical care, such as diabetes, ulcers, and infections. Routine hygienic care is not covered unless there is a medical condition.
Private Duty Nursing n Private duty nursing services are medically necessary services given to you at your permanent or temporary home by licensed registered professional or licensed practical nurses (RNs or LPNs) that follow provider orders. The services may be ongoing and may go above the line of care from certified home healthcare agencies (CHHAs).
Respiratory Therapy n Delivery of preventive, maintenance, and rehabilitative airway-related techniques and procedures, including oxygen and other inhalation therapies prescribed by a provider and given by a qualified company/respiratory therapist.
Social Day Care n A program that gives members who have limited functions socialization, supervision and monitoring, and nutrition. Care is given in a safe setting during any part of the day, but for less than a 24-hour period. Other services may include, but are not limited to, personal care help, teaching daily living skills, transportation, caregiver help, and case help.
15 Senior Health Partners Member Handbook Covered Services Definition
Social and Environmental n Services and items include, but are not limited to, home Supports maintenance tasks, homemaker/care services, housing improvement, and respite care.
Telehealth Services n Electronic information and communication technologies to deliver healthcare services like assessment, diagnosis, consultation, treatment, education, care management, and/or self-management.
Nursing Home Care from a nursing home back into your home or residence in the community. New York State changed how nursing home You may qualify for MFP if you: benefits will be covered for people in Senior Health Partners. Senior Health Partners will n have lived in a nursing home for three only cover three (3) months of long-term (3) months or longer. nursing home care if certain criteria is met. n have health needs that can be met through If you are in a long-term nursing home for services in your community. more than three (3) months and you meet the criteria, you will be disenrolled from MFP/Open Doors has people, called Transition Senior Health Partners. If you still qualify Specialists and Peers, who can meet with you for Medicaid coverage of your nursing home in the nursing home and talk with you about care, you may remain in your nursing home moving back to the community. Transition after disenrollment. Specialists and Peers are different from Care Managers and Discharge Planners. They can Services for Veterans help you by: If you want to get care from a veterans’ home, n giving you information about services and you can for up to three (3) months. Your supports in the community. eligibility for veterans’ homes is based on n clinical need and availability in the home. finding services offered in the community New York State veterans’ homes are limited to help you be independent. to veterans, non-veteran spouses, and n visiting or calling you after you move to gold star parents. make sure that you have what you need at home. Money Follows the Person For more information about MFP/Open Doors, (MFP)/Open Doors or to set up a visit from a Transition Specialist or Peer, please call the New York Association on This section explains the services and supports Independent Living at 1-844-545-7108, that are available through Money Follows or email [email protected]. the Person (MFP)/Open Doors. MFP/Open You can also visit MFP/Open Doors at Doors is a program that can help you move www.health.ny.gov/mfp or www.ilny.org.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 16 Non-Covered Services1 What services are not covered by Senior Health Partners?
The services below are not covered by Senior Health Partners. They are covered by Medicaid and/or Medicare.
Non-Covered Services Definition Inpatient Hospital A hospital (or other institutional bed) to get care, including room, Care Services board, and general nursing.
Outpatient Hospital Care that you get in a clinic, medical office, or other place that Care Services does not have a “regular” hospital bed.
Provider Services Preventive care, primary medical care, and specialty services given to you by a provider. This includes nurse practitioners and provider assistants who work with the provider. Provider services can include services given in an office setting, a clinic, a facility, or in the home.2
Alcohol and Substance Treatment to end too much use of bad substances such as alcohol Abuse Services or drugs.
Process used to treat advanced and permanent kidney failure at Chronic Renal Dialysis a renal dialysis center.
Emergency Transportation by ambulance when you have an emergency. Transportation
Family Planning Contraceptive and birth control services. Services
Full care for people who are terminally ill (a medical issue that leads to death). Services include pain management, counseling, respite care, prescription drugs, inpatient care and outpatient care, and services for the person’s family. If you need and are eligible for hospice services while still a Hospice Services member, you can get hospice without disenrolling from Senior Health Partners. Hospice services are not included in the plan benefit and are billable directly to Medicare and Medicaid. However, if you are a resident of a skilled nursing facility (SNF) and you enroll in hospice while in the SNF, Senior Health Partners will pay for the room and board portion of your SNF stay.
Laboratory and Tests and procedures ordered by a qualified medical professional. Radioisotope Services
17 Senior Health Partners Member Handbook Non-Covered Services Definition Medical specialty that helps with the prevention, diagnosis, Mental Health Services and treatment of mental illness.
Prescription and Non-Prescription Medications prescribed and/or recommended by a provider. Drugs, Compounded Prescriptions prepared by a pharmacist. Prescriptions
Office for People Long-term therapy services given by treatment facilities certified with Developmental by OPWDD; comprehensive Medicaid Case Management services; Disabilities (OPWDD) and home and community-based waiver program services for the Services developmentally disabled.
Rural Health Clinic Federally Qualified Health Centers (FQHCs) that have affordable, Services quality, primary care services.
All Other Services Listed in the Title XIX State Services paid for by Medicaid Fee-for-Service. Plan Benefits cannot be transferred from you to any other person or organization. 1Non-covered services will be paid for by Medicare, Medicaid Fee-for-Service, Private Pay member, or Third Party Insurance, if applicable. For all members, including Private Pay, we will coordinate these services for you. See Private Pay Section. 2Includes nurse practitioners and provider assistants who work with the provider.
Non-Covered Services Section. By doing so, How to Obtain your Care Team will be able to manage your care Covered Services in the best way possible. When you enroll in Senior Health Partners, you, Your PCSP will be updated when your care your provider, and your Care Team will work plan and services change. Your Care Team will together to develop a Person Centered Service refer and manage medical, social, educational, Plan (PCSP) to meet your healthcare needs. Your psychosocial, financial, and other services to meet PCSP is based on your Care Team’s assessment your needs. (Please see Requesting Additional of your healthcare needs, the recommendations Services or Changes to the PCSP Service and of your provider, and input from you, your family, Authorization for Services later in this section.) or caregivers. It will include medically necessary Your PCSP is based on New York’s Uniform services to manage your current conditions. Assessment System (UAS), a standard assessment The PCSP will also include goals, objectives, used to see how well you are doing and to see and special needs. You will get a written copy what health problems you have. You will receive of your PCSP. a re-assessment at least every 6 months or when Your Care Team will monitor and evaluate your there are any major changes in your condition. health status and care needs on a regular basis. The Care Team will also schedule a monthly It is important that you talk with your Care Team care management call with you, so you can ask to let them know what you need. It is also questions or discuss your concerns about your important to let them know when you have used covered services. a non-covered service. See Covered and
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 18 A member of your Care Team will arrange the n you need more in-home healthcare services. covered services that you need. This may include setting up transportation to and from all n you need other covered services. non-emergent medical appointments, providing Your Care Team will review your request and you with home-delivered meals, and arranging decide if they are medically necessary. They may for home care. They will also help you get talk with your provider about the services and non-covered services. For example, they may other changes you asked for. help you find providers for non-covered services, schedule appointments, or schedule If your Care Team approves, the service will be transportation. Your Care Team will help you given and you will get a letter about the newly with hospital outpatient services. approved services. If your request is denied, you will get a denial letter, also known as an Initial A member of Senior Health Partners’ Care Team Adverse Determination (IAD). Senior Health is available 24 hours a day, 7 days a week, Partners will give you an IAD letter when we deny to answer your questions. or limit requested services. See Complaints and Appeals Process Section. Authorization for Services Most of the covered services that you get must Emergency Services be approved by your Care Team. Some of the An emergency is a sudden change in medical services also require a doctor’s order: Consumer condition or behavior that is so severe that if you Directed Personal Assistance Services (CDPAS), do not get medical attention you would be in home healthcare, nursing home care, rehabilitative danger. A medical emergency can include severe therapies, respiratory therapy, durable medical pain, an injury, or sudden illness. equipment, prosthetics, and orthotics. Non-emergent transportation, environmental When you have a medical emergency, you or supports, and home-delivered meals must be your caregiver should call 911. This is the best way approved by your Care Team but do not require to get the care you need as quickly as possible. a doctor’s order. You can go to the podiatrist, However, you can always call us. Someone will be dentist, audiologist, and optometrist for tests and able to help you 24 hours a day, 7 days a week. routine services without prior approval by your Care Team. If you get these services on your If you need to reach us in an emergency, own, Senior Health Partners asks that you contact call 1-800-633-9717. a member of your Care Team. You do not need approval from Senior Health If you need help getting any covered service, talk Partners to get emergency services. You do to any member of your Care Team. They can not need to call us for emergency services. schedule an appointment and transportation with After you get emergency care, call us as soon as the provider. Emergency or urgent care services possible. This will help us to handle your care in do not have to be ordered by your provider or the best way. approved by your Care Team. Care Received Outside Requesting Additional Services or the Senior Health Changes to the Person Centered Service Plan (PCSP) Partners Service Area If you will be out of the Senior Health Partners’ Contact any member of your Care Team if: service area for a while (a few days or more), n you or your provider feels that you need you must call your Care Team. We’re available a covered service. 24 hours a day, 7 days a week at:
n you would like to change your PCSP. 1-800-633-9717 Your Care Team can manage your care for up to 30 (thirty) days while you are away. During that
19 Senior Health Partners Member Handbook time, we can help you with any issues you have has been made and you have agreed to the new about your care, and with getting other services. plan of care, whichever is earlier. If you are away for more than 30 (thirty) days in Your Care Team may authorize an out-of-network a row (with or without telling us), we will have to provider of a covered service. Senior Health start the disenrollment process. This will begin Partners will authorize it if the expertise or within five (5) business days of knowing you have the service is not available in our network. been away from the service area for more than Under these circumstances, we will pay for 30 (thirty) days in a row. this covered service. Transitional and Disenrollment, Specialty Care Termination of If, before you enroll, you are being treated by a Benefits, and Voluntary non-network provider for an ongoing course of treatment, we will pay the provider after you are Disenrollment enrolled. This will last for up to 60 (sixty) days or until the Person Centered Service Plan (PCSP) is Voluntary Disenrollment in place, for any covered service that you get as part of the treatment. However, the provider must You can disenroll from Senior Health Partners agree to accept our payment rate as payment at any time during the first 90 (ninety days) or in full, must agree to follow our policies and grace period of enrollment. We will work with procedures, and must agree to provide medical you and/or your authorized representative to information about your plan of care. ensure a smooth transfer to another Managed Care or Managed Long-Term Care (MLTC) plan. If you are being treated by a network provider To successfully process the request to disenroll, for an ongoing course of treatment while you are you or your representative must give us a verbal enrolled, and the provider leaves the network, or written request. If you will still need services we will continue to pay the provider for any such as personal home care, your Care Team covered service that you get. This will last for up can assist you in contacting New York Medicaid to 90 (ninety) days if the provider continues Choice at 1-888-401-6582. You can also call New to treat you after they have left the network. York Medicaid Choice directly to select another However, the provider must agree to accept our MLTC plan, Managed Care plan, or ask for a waiver payment rate as payment in full, must agree to service to continue to get community-based follow our policies and procedures, and must long-term care services. agree to give us medical information about your plan of care. We will send you written notification (of your request to disenroll), which will begin no later than Senior Health Partners cannot deny payment to the first day of the second month after the month your current providers during a transition period, when you asked for disenrollment. even if they do not request prior authorization. For private pay members, disenrollment is effective If you are transitioning with a pre-existing service on the last day of the month when disenrollment plan from Medicaid Fee-for-Service (FFS) to MLTC, was requested. Once disenrollment is confirmed, your first 90 (ninety) days of membership or until written confirmation will be mailed to you. your PCSP has been approved, whichever is later, is covered. If you are enrolled in Senior Health Partners and you apply for services from another MLTC Your same plan of care will be covered for the first plan, a Home and Community Based Services 120 (one hundred twenty) days after enrollment waiver program, or an Office for People with as a result of: your previous plan’s closure; service Developmental Disability Day Treatment program, area reduction; or if a merger, acquisition, or other this will begin your disenrollment from Senior arrangement approved by the Department of Health Partners. Health (DOH) has occurred or until an assessment
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 20 If you choose to disenroll from Senior Health For private pay members, involuntary Partners and do not enroll into another MLTC disenrollment does not require the approval of plan, Managed Care plan or waiver program, NYMC, LDSS, or place chosen by the NYSDOH. your Medicaid coverage will be managed by your Private pay members do not have a right to a Local Department of Social Services, and you will Fair Hearing. See Private Pay Section. no longer be able to receive Community-Based Long-Term Care Services (CBLTCS). Senior Health Partners must disenroll you within five (5) business days from the date we become Once the 90-(ninety) day grace period has aware of any of the below. passed, you will be unable to make any changes to your enrollment during the following nine (9) n You move out of Manhattan, Bronx, Brooklyn, months, unless you have a good reason (good Queens, Staten Island or Nassau or cause). Some examples of good cause include: Westchester counties.
n n You move out of our service area. You leave Manhattan, Bronx, Brooklyn, Queens, Staten Island or Nassau or Westchester n You, the plan, and your county Department of counties for any reason for more than 30 (thirty) Social Services or the New York State days in a row with or without telling us. Department of Health all agree that leaving Senior Health Partners is best for you. n You lose your right to get benefits from the Medicaid program, you don’t regain those n Your current home care provider does not benefits within your 90-(ninety) day grace work with our plan. period, and you do not want to privately pay. NOTE: Private Pay does not apply to Staten n We have not been able to provider services to Island, Nassau, or Westchester residents. you as we are required to under our contract with the State. n You are hospitalized or enter an Office of Mental Health, Office for People with If you qualify, you can change to another type Developmental Disabilities, or Office of of managed long-term care plan like Medicaid Alcoholism Substance Abuse Services Advantage Plus (MAP) or Programs of All-Inclusive residential program for 45 (forty-five) Care for the Elderly (PACE) at any time without any days in a row or longer. good cause. n You require nursing home care, but you Involuntary Disenrollment are not eligible under the Medicaid Program’s institutional eligibility rules. There are some times when Senior Health Partners will disenroll a member from the plan. Before n You are not eligible for MLTC because you this happens, we will outreach the member and/ are assessed as no longer demonstrating or authorized representative to assist with any a functional or clinical need for the presenting issues that is placing member at risk authorization and delivery of any for disenrollment. If you are being involuntarily community-based long-term care services on disenrolled, you will be sent a written notice. You a monthly basis or, for non-dual eligible will need to select another MLTC plan or Managed enrollees who no longer meets the nursing Care Program, or waiver service, to continue home level of care as determined using the receiving your long-term care services, such as assessment tool prescribed by the personal care. If you do not choose a new plan, Department. If your sole service is identified as you will be auto-enrolled to a new plan by New Social Day Care, you will be disenrolled from York State Department of Health (NYSDOH). the MLTC plan. Senior Health Partners will provide LDSS or entity designated by the Once your disenrollment is approved by New York Department, the result of its assessment and Medicaid Choice (NYMC), LDSS, or plan chosen recommendation regarding disenrollment by the New York State Department of Health within five (5) business days of making such (NYSDOH), they will send you written notification determination. of your right to a Fair Hearing. Senior Health Partners will send you written confirmation of n You do not need or get at least one of these your disenrollment. CBLTCS in each calendar month:
21 Senior Health Partners Member Handbook ➤ Nursing services in the home members, disenrollment begins the last day of the month disenrollment was initiated. See Private Pay ➤ Therapies in the home Section. Until your disenrollment is confirmed, ➤ Home Health Aide services Senior Health Partners will provide covered services according to your Person Centered ➤ Personal Care services in the home Service Plan (PCSP). During this time, your Care Team can assist in locating other providers to ➤ Adult Day Health Care transfer your care to them. n You are incarcerated. The effective date of disenrollment will be the first day of the Re-Enrollment Provisions month following the incarceration. If you voluntarily disenroll, you can re-enroll in n You provide us with false information, Senior Health Partners if you meet the enrollment otherwise deceive us, or engage in fraudulent eligibility measures. If you are involuntarily conduct with respect to any substantive disenrolled, you can re-enroll in the plan if your aspect of your plan membership. disenrollment issues or disputes were resolved.
n You become homeless and your current shelter does not allow for home care services. Complaints and
n You are in long-term care, for more than Complaint Appeals 90-(ninety) days, in a nursing home and you meet specific criteria. Process Senior Health Partners will handle your problems Senior Health Partners may choose to disenroll or complaints as quickly as possible. You can use you if: our complaint process or our appeal process. If n You or your family members or caregivers you file a complaint or an appeal, your services will use disruptive behavior that seriously harms not change, and we will not treat you differently. our ability to give services to you or others, We will keep your information private. We will help even when we tried to stop the problems you you file a complaint or appeal. We will also give were creating. you interpreter services or help with vision and/or hearing problems. You can use someone to act for n You do not pay or arrange to pay your private you (like a relative or friend or a provider). pay (see Private Pay Section). To file a complaint or to appeal a plan decision, n You do not pay or arrange to pay your please call 1-800-633-9717, or write us at: Medicaid spend down within 30 (thirty) days after it is due (even though we gave you Senior Health Partners Plan a written demand for payment and told you Attn: Appeals and Complaints that you will be disenrolled for non-payment). P.O. Box 5166 New York, NY 10274-5166 Senior Health Partners cannot disenroll you because of a chronic decline in your health status, If you call us, you will need to give us your name, the medical services you use, your decreased address, telephone number, and the details of the cognitive skills, disruptive behavior due to your problem. If you write to us, please include these medical condition or special needs. details in writing. Effective Date of Disenrollment What is a Complaint? and Coordination of Transfer to A complaint is any message from you to us of unhappiness about care or treatment you get from Other Service Providers our team or providers of covered services. For Your disenrollment will begin on the last day of example, if someone was rude to you or you did the month after it is processed by NYMC, LDSS, not like the quality of care or services you got, you or place chosen by NYSDOH. For private pay can file a complaint.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 22 The Complaint Process SERVICE AUTHORIZATIONS, You can file a complaint over the phone or in ACTIONS, and ACTION writing. We will record it, and one of our team will review your complaint. We will send you a letter APPEALS telling you that we got it and give you information about our review process. You will get a written When you ask for approval of a treatment or answer within a standard response timeframe or service, it is called a service authorization request. within an expedited timeframe (see below). To submit a service authorization request, you or your provider may call Senior Health Partners 1.If a delayed response would risk your health, Member Services at 1-800-633-9717. For TTY we will decide within 48 hours after we get services, call 1-888-542-3821. You can also send the information, but no longer than seven (7) your request in writing to: days of receiving the complaint. This is an expedited response. Healthfirst Member Services P.O. Box 5165 2. For all other types of complaints, we will New York, NY 10274-5165 contact you within 45 (forty-five) days of getting the necessary information, but no We will authorize services in a certain amount longer than 60 (sixty) days of receiving the for a specific period of time. This is called an complaint. This is a standard response. authorization period. We will tell you what we found when we review Prior Authorization your complaint. We will also give you the decision about your complaint. Some covered services require prior authorization (approval in advance) from Senior Health Partner’s How do I Appeal a Complaint Utilization Management department before you receive them, or in order to be able to continue Decision? receiving them. You or someone you trust can If you are not satisfied with the decision we ask for this. For a list of treatments and services make, you can ask for a second review by filing a that must be approved before you get them, complaint appeal in writing. It must be filed within please see the Covered Services section of this 60 (sixty) business days of receiving the first Member Handbook. decision about your complaint. When we get it, we will send you a notice with the person who will Concurrent Review respond to your complaint appeal. All complaint You can also ask Senior Health Partner’s Utilization appeals will be reviewed by someone who was not Management department to get more of a involved in the first decision. service than you are getting now. This is called For standard complaint appeals, we will give you concurrent review. a decision within 30 (thirty) business days after we get all the necessary information. If a delay Retrospective Review in making our decision would risk your health, we will use the expedited complaint appeal Sometimes we will do a review on the care you process. This means, we will make our appeal are getting to see if you still need the care. We decision within two (2) business days after we may also review other treatments and services you get all the necessary information. For both types are already receiving. This is called retrospective of complaint appeals, we will send you a notice review. We will tell you if we do these reviews. with our decision. It will include detailed reasons for our decision, and in cases involving clinical What happens after we get your matters, the clinical rationale for our decision. service authorization request? The plan has a review team to be sure you get the services we promise. Doctors and nurses are on the review team. Their job is to be sure the
23 Senior Health Partners Member Handbook treatment or service you asked for is medically n Fast track review: We will make a decision needed and right for you. They do this by checking within 1 workday of when we have all the your treatment plan against acceptable medical information we need. You will hear from us standards. within 72 hours, after we receive your request. We will tell you within 1 workday, if we need We may decide to deny a service authorization more information. request or to approve it for an amount that is less than requested. These decisions will be made If we need more information to make either by a qualified health care professional. If we a standard or fast track decision about your decide that the requested service is not medically service request, the timeframes can be extended necessary, the decision will be made by a clinical up to 14 days. We will: peer reviewer, who may be a doctor, a nurse or a health care professional who typically provides the n Write and tell you what information is needed. care you requested. You can request the specific If your request is in a fast track review, we will medical standards, called clinical review criteria, call you right away and send a written notice used to make the decision for actions related to later. medical necessity. n Tell you why the delay is in your best interest.
After we get your request, we will review it under a n Make a decision as quickly as we can, when standard or fast track process. You or your doctor we receive the necessary information, but no can ask for a fast track review if it is believed that later than 14 days from the day we asked for a delay will cause serious harm to your health. more information. If your request for a fast track review is denied, we will tell you and your request will be handled You, your provider, or someone you trust may also under the standard review process. In all cases, ask us to take more time to make a decision. This we will review your request as fast as your medical may be because you have more information to condition requires us to do so, but no later than give the plan to help decide your case. This can indicated below. be done by calling Senior Health Partners Member Services at 1-800-633-9717. For TTY services, call Timeframes for prior 1-888-542-3821. You can also send your request authorization requests in writing to: Healthfirst Member Services n Standard review: We will make a decision P.O. Box 5165 about your request within 3 workdays of when New York, NY 10274-5165 we have all the information we need, but you will hear from us no later than 14 days after You or someone you trust can file a complaint we receive your request. We will tell you by with the plan, if you don’t agree with our decision the 14th day, if we need more information. to take more time to review your request. You or someone you trust can also file a complaint n Fast track review: We will make a decision, about the review time with the New York State and you will hear from us, within 72 hours. Department of Health by calling 1-866-712-7197. We will tell you within 72 hours if we need more information. If our answer is yes to part or all of what you asked for, we will authorize the service or give you Timeframes for concurrent the item that you asked for. review requests If our answer is no to part or all of what you asked for, we will send you a written notice that n Standard review: We will make a decision explains why we said no. See How Do I File an about your request within 1 workday of when Appeal of an Action? which explains how to make we have all the information we need, but you an appeal if you do not agree with our decision. will hear from us no later than 14 days after we receive your request. We will tell you by the 14th day, if we need more information.
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 24 What is an Action? The notice will also tell you about your right to an appeal and a State Fair Hearing: When Senior Health Partners denies or limits services requested by you or your provider; denies n It will explain the difference between an a request for a referral; decides that a requested appeal and a Fair Hearing; service is not a covered benefit; restricts, reduces, n It will say that that you must file an appeal suspends or terminates services that we already before asking for a Fair Hearing; and authorized; denies payment for services; doesn’t provide timely services; or doesn’t make complaint n It will explain how to ask for an appeal. or appeal determinations within the required timeframes, those are considered plan “actions. An If we are reducing, suspending, or terminating action is subject to appeal. (See How do I File an an authorized service the notice will also tell you Appeal of an Action? below for more information.) about your rights to have your services continued while your appeal is decided. To have your services Timing of Notice of Action continued you must ask for an appeal within 10 days of the date on the notice or the intended If we decided to deny or limit services you effective date of the proposed action, whichever requested or decide not to pay for all or part of a is later. covered service, we will send you a notice when we make our decision. If we are proposing to How do I File an Appeal of restrict, reduce, suspend or terminate a service that is authorized, our letter will be sent at least 10 an Action? days before we intend to change the service. If you do not agree with an action that we have taken, you may appeal. When you file an appeal, Contents of the Notice of Action it means that we must look again at the reason for our action to decide if we were correct. You Any notice we send to you about an action will: can file an appeal of an action with the plan orally n Explain the action we have taken or intend or in writing. When the plan sends you a letter to take; about an action it is taking (like denying or limiting services, or not paying for services), you must file n Cite the reasons for the action including your appeal request within 60 days of the date the clinical rationale, if any; on the notice. If we are reducing, suspending, or terminating an authorized service and you want n Describe your right to file an appeal with us your services to continue while your appeal is (including whether you may also have a right decided, you must ask for an appeal within 10 days to the State’s external appeal process); of the date on the notice or the intended effective n Describe how to file an internal appeal and date of the proposed action, whichever is later. the circumstances under which you can request that we speed up (expedite) our How Do I Contact My Plan review of your internal appeal; to File an Appeal? n Describe the availability of the clinical review You can contact Senior Health Partners by calling criteria relied upon in making the decision, 1-800-633-9717 or writing to: if the involved issues of medical necessity or whether the treatment or service in question Senior Health Partners Plan was experimental or investigational; Attn: Appeals and Complaints P.O. Box 5166 n Describe the information, if any, that must be New York, NY 10274-5166 provided by you and/or your provider in order for us to render a decision on appeal. The person who receives your appeal will record it, and appropriate staff will oversee the review of the appeal. We will send a notice telling you that we received your appeal, include a copy of your case file which includes medical records and other
25 Senior Health Partners Member Handbook documents used to make the original decision, or terminate services, and services were not and how we will handle it. Your appeal will be furnished while your appeal was pending, we will reviewed by knowledgeable clinical staff who were provide you with the disputed services as quickly not involved in the plan’s initial decision or action as your health condition requires. In some cases, that you are appealing. you may request an “expedited” appeal. (See Expedited Appeal Process Section below.) For Some Actions You May Request to Continue Service Expedited Appeal Process During the Appeal Process We will always expedite our review if the appeal is about your request for more of a service you are If you are appealing a restriction, reduction, already receiving. If you or your provider feels that suspension, or termination of services you are taking the time for a standard appeal could result currently authorized to receive, you must request in a serious problem to your health or life, you a plan appeal to continue to receive these may ask for an expedited review of your appeal. services while your appeal is decided. We must of the action. We will respond to you with our continue your service if you ask for a plan appeal decision within 2 business days after we receive no later than 10 days from the date on the notice all necessary information. In no event will the time about the restriction, reduction, suspension or for issuing our decision be more than 72 hours termination of services or the intended effective after we receive your appeal. (The review period date of the proposed action, whichever is later. To can be increased up to 14 days if you request an find out how to ask for a plan appeal, and to ask extension or we need more information, and the for aid to continue, see How do I File an Appeal of delay is in your interest.) an Action? above. If we do not agree with your request to expedite Although you may request a continuation of your appeal, we will make our best efforts to services, if the plan appeal is not decided in your contact you in person to let you know that we favor, we may require you to pay for these services have denied your request for an expedited appeal if they were provided only because you asked to and will handle it as a standard appeal. Also, we continue to receive them while your case was will send you a written notice of our decision to being reviewed. deny your request for an expedited appeal within 2 days of receiving your request. How Long Will It Take the Plan to Decide My Appeal of an Action? If the Plan Denies My Appeal, What Can I Do? Unless your appeal is expedited, we will review your appeal of the action taken by us as a standard If our decision about your appeal is not totally in appeal. We will send you a written decision as your favor, the notice you receive will explain your quickly as your health condition requires, but right to request a Medicaid Fair Hearing from New no later than 30 days from the day we receive York State and how to obtain a Fair Hearing, who an appeal. (The review period can be increased can appear at the Fair Hearing on your behalf, and up to 14 days if you request an extension or we for some appeals, your right to request to receive need more information, and the delay is in your services while the Hearing is pending and how to interest.) During our review you will have a chance make the request. to present your case in person and in writing. We will also send you your records that are part of Note: You must request a Fair Hearing within 120 the appeal review. calendar days after the date on the Final Adverse Determination Notice. We will send you a notice about the decision we made about your appeal that will identify If we deny your appeal because of issues of the decision we made and the date we reached medical necessity or because the service in that decision. question was experimental or investigational, the notice will also explain how to ask New York State If we reverse our decision to deny or limit for an “external appeal” of our decision. requested services, or restrict, reduce, suspend
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 26 State Fair Hearings n Request by Telephone: If we deny your plan appeal or fail to provide a ➤ Standard Fair Hearing line – Final Adverse Determination notice within the 1-800-342-3334 timeframes under How Long Will It Take the ➤ Emergency Fair Hearing line – Plan to Decide My Appeal of an Action? above, 1-800-205-0110 you may request a Fair Hearing from New York State. The Fair Hearing decision can overrule our ➤ TTY line – 711 (request that the operator decision. You must request a Fair Hearing within call 1-877-502-6155) 120 calendar days of the date we sent you the Final Adverse Determination notice. n Request in-person: If we are reducing, suspending or terminating New York City Albany an authorized service and you want to make 14 Boerum Pl, 1st Fl 40 North Pearl St, 15th Fl sure that your services continue pending the Fair Brooklyn, NY 11201 Albany, NY 12243 Hearing, you must make your Fair Hearing request within 10 days of the date on the Final Adverse For more information on how to request a Fair Determination notice. Hearing, please visit: http://otda.ny.gov/hearings/ request/ Your benefits will continue until you withdraw the Fair Hearing or the State Fair Hearing Officer State External Appeals issues a hearing decision that is not in your favor, whichever occurs first. If we deny your appeal because we determine the service is not medically necessary or is If the State Fair Hearing Officer reverses our experimental or investigational, you may ask for an decision, we must make sure that you receive external appeal from New York State. The external the disputed services promptly, and as soon as appeal is decided by reviewers who do not work your health condition requires. If you received the for us or New York State. These reviewers are disputed services while your appeal was pending, qualified people approved by New York State. You we will be responsible for payment for the covered do not have to pay for an external appeal. services ordered by the Fair Hearing Officer. When we make a decision to deny an appeal for Although you may request to continue services lack of medical necessity or on the basis that the while you are waiting for your Fair Hearing service is experimental or investigational, we will decision, if your Fair Hearing is not decided in your provide you with information about how to file favor, you may be responsible for paying for the an external appeal, including a form on which to services that were the subject of the Fair Hearing. file the external appeal along with our decision to You can file a State Fair Hearing by contacting the deny an appeal. If you want an external appeal, Office of Temporary and Disability Assistance: you must file the form with the New York State Department of Financial Services within four n Online Request Form: https://errswebnet. months from the date we denied your appeal. otda.ny.gov/errswebnet/erequestform.aspx Your external appeal will be decided within 30 n Mail a Printable Request Form to: days. More time (up to 5 business days) may be needed if the external appeal reviewer asks for NYS Office of Temporary and more information. The reviewer will tell you and us Disability Assistance of the final decision within two business days after Office of Administrative Hearings the decision is made. Managed Care Hearing Unit P.O. Box 22023 You can get a faster decision if your doctor can Albany, New York 12201-2023 say that a delay will cause serious harm to your health. This is called an expedited external appeal. n Fax a Printable Request Form: The external appeal reviewer will decide an 1-518-473-6735 expedited appeal in 72 hours or less. The reviewer
27 Senior Health Partners Member Handbook will tell you and us the decision right away by phone or fax. Later, a letter will be sent that tells Quality Assurance and you the decision. Improvement Program You may ask for both a Fair Hearing and an Senior Health Partners has a Quality Management external appeal. If you ask for a Fair Hearing and System to track and measure the quality and an external appeal, the decision of the Fair Hearing importance of care and service. This detailed officer will be the “one that counts.” system must meet the New York State health and Contacting the New York State long-term care quality assurance standards. Department of Health Our Quality Management System finds opportunities for improving: If at any time you are unhappy with how Senior Health Partners has treated you, or how we have n quality of service given. handled your complaint, call or write to the New York State Department of Health: n management of care (including availability, access and continuity). NYS Department of Health Bureau of Managed Long-Term Care n identification and correction of operational Suite 1620, One Commerce Plaza and care management practices. 99 Washington Ave., Albany, NY 12210 n results in clinical, non-clinical, and 1-866-712-7197 functional areas. You can also call the Independent Consumer The quality management system includes a plan Advocacy Network (ICAN) (also known as a Participant Ombudsman program) to get free to look for areas where improvement is needed, advice about your health coverage, complaints, a process for the continuous improvement of and appeal options. They can talk to you about a performance, a review of the credentials of all Medicaid Managed Long Term Care (MLTC) plan providers providing care or service, maintenance (like Senior Health Partners) before you decide to of health information records, and review of enroll in one. They can give you fair health plan service use. choice counseling and general plan information. They can also help you with the appeal process. We welcome your suggestions about quality Contact ICAN to learn more about their services: improvement. Phone: 1-844-614-8800 (TTY Relay Service: 711) Web: www.icannys.org Email: [email protected] Senior Health Partners will work with ICAN (when needed) to help them with their duties. Senior Health Partners will also give ICAN a current list of its participating providers (if they ask for it).
Thank you for choosing Senior Health Partners, where home is your first choice for long-term care! Healthfirst.org/Senior-Health-Partners-Plan
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 28 Community Offices Near You
BRONX QUEENS LONG ISLAND (continued) East Tremont Elmhurst SUFFOLK COUNTY Bay Shore 774 E. Tremont Avenue 40-08 81st Street (between Prospect (between Roosevelt Westfield South Shore Mall and Marmion Avenues) and 41st Avenues) 1701 Sunrise Highway (in the JCPenney Wing) Fordham Flushing Lake Grove 412 E. Fordham Road 41-60 Main Street (entrance on Webster Avenue) Rooms 201 & 311 Smith Haven Mall (between Sanford 313 Smith Haven Mall BROOKLYN and Maple Avenues (in the Sears Wing) Bensonhurst Main Plaza Mall Patchogue 2236 86th Street 37-02 Main Street 99 West Main Street (between Bay 31st (between 37th and 38th Avenues) (between West and Bay 32nd Streets) Jackson Heights and Havens Avenues) Flatbush 93-14 Roosevelt Avenue Shirley (between Whitney Avenue 2166 Nostrand Avenue La Placita (between Avenue H and 94th Street) 58 D Surrey Circle and Hillel Place) Jamaica (between William Floyd Parkway and Floyd Road) Sunset Park Jamaica Colosseum Mall 89-02 165th Street, Main Level 5324 7th Avenue WESTCHESTER COUNTY (between 53rd and 54th Streets) (between 89th and Jamaica Avenues) Yonkers MANHATTAN Richmond Hill 13 Main Street (between Warburton Avenue Chinatown 122-01 Liberty Avenue and N Broadway) (between 122nd 128 Mott Street, Room 407 and 123rd Streets) (between Grand and Hester Streets) ORANGE COUNTY 28 E. Broadway LONG ISLAND Middletown (between Catherine Galleria at Crystal Run and Market Streets) NASSAU COUNTY Hempstead 1 Galleria Drive, Lower Level (in the Macy’s Wing) Harlem 242 Fulton Avenue 34 E. 125th Street (between N. Franklin (corner of 125th Street and Main Streets) and Madison Avenue) Valley Stream Washington Heights Green Acres Mall 1467 St. Nicholas Avenue 2034 Green Acres Mall (between W. 183rd Sunrise Highway, Level 1 and W. 184th Streets) (in the Kohl’s Wing)
Community office locations subject to change. For the most up-to-date locations, please visit healthfirst.org/locations.
29 Senior Health Partners Member Handbook Notes
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 30 Notes
31 Senior Health Partners Member Handbook Notes
Healthfirst.org/Senior-Health-Partners-Plan | Member Services 1-800-633-9717 (TTY 1-888-542-3821) | 24/7, 365 Days per Year 32 Connect with us on social media at HealthfirstNY for events and activities.
For questions about Senior Health Partners, call Member Services at 1-800-633-9717 (TTY 711), 24/7, 365 days per year. To access your secure Healthfirst account, visit us at MyHFNY.org. We’re mobile-optimized, so you can use your smartphone or any mobile device!
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.
© 2020 HF Management Services, LLC 1562-20_EN