Common Contracts

Memorandum of Understanding between the Centers for Medicare & Medicaid Services (CMS) and the New York State Department of Health to Operate Integrated Grievance and Appeals Processes for Certain Integrated Medicare and Medicaid Plans

February 24th, 2020

• Filed
  February 24th, 2020

This Demonstration is testing integrated grievance and appeals processes that will apply to all items and services covered by participating MAP plans and MAP-participating D-SNPs other than those provided under Medicare Part D. The integrated grievance and appeals process does not apply to: 1) Medicare and Medicaid items and services that are excluded from the plans’ benefit packages; and 2) Medicare Part D benefits. MAP plans and MAP-participating D-SNPs will apply the integrated grievance process described in 42 CFR § 422.630 to all plan-level grievances, whether relating to Medicare or to Medicaid. The plans will also apply the integrated coverage determination and reconsideration process described at 42 CFR § 422.629 and §§ 422.631 through 422.634. Any modifications to the grievance and plan-level appeals rules under 42 CFR §§ 422.629-422.634 will be consistent with the flexibilities available under those rules and are described in Appendix 3 to the MOU. For appeals subsequent to t