New York State Dept of Health Prior Approval Out-of-State Medicaid Placements

Special Populations within Long Term Care


The purpose of prior approval for out of state placement is to ensure all reasonable possibilities for instate placement of a New York Medicaid recipient with special care needs are exhausted before consideration to an out-of-state placement is given.

Prior Approval Process:

Involved onsite screen by provider agencies, prior approval proposal package including relevant medical records, review of facilities already referred to and reason for denial, review of available in state options with suggestions for additional New York State options given whenever possible and review of clinical components of proposed plan of care for out of state facility.

Care is monitored through progress reports and unannounced site visits to ensure clinical needs are being met and transitional discharge plans initiated early in the care planning process in order to facilitate repatriation to an appropriate level of care in New York State as soon as practicable.

General Diagnostic Groups Served Through this Process:

Traumatic Brain Injury, Neurobehavioral Disorders, Huntington's Disease, multiple medical co-morbidities unable to successfully treated in New York State due to the uniqueness of the constellation of needs.

Stimulating Development within New York State:

The prior approval process allows New York State to learn about trends of populations whose needs are not being currently met or consistently met within New York State with the further understanding of what the successful treatment protocols are so replication of these successful models may be initiated within New York State keeping residents in or near their home communities.