Home-based care that never slows you down
You’re one step closer to long-term care that keeps you going, improving your quality of life in the comfort of your community.
Care that benefits you
Unlimited Access
When you enroll in this the Hamaspik Choice Managed Long Term Care (MLTC) plan, you have access to home- and community-based, long-term care that keeps you living your best life.
Vast Network
Our provider network includes home- and community-based support for those that need long-term care. The network features many of New York’s leading long-term care providers and their affiliated doctors.
Your prescription for better health
How Hamaspik makes getting your prescriptions a priority
Broad Formulary of Covered Medications
Each Hamaspik plan uses an established drug list (known as ‘The Formulary’) that has been approved by CMS (The Centers for Medicare and Medicaid Services). The drug list includes both brand name and generic drugs in all medication categories. Just speak with your doctor about the drugs you need, and show them the formulary for your plan.
Vast Pharmacy Network
You can get your medications at any of the thousands of pharmacies in our network, including all major drug store chains and many independent pharmacies. You can also order your medications to be delivered via mail.
Flexible Options
If you are taking a drug that is not included in the Hamaspik Medicare Select formulary, we will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new, and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication. The prescription must be filled at a network pharmacy. This will ensure that your health needs are always met. Be sure to talk with your doctor during this time to prescribe a different drug or to file an exception request.
Manage your medications
Each Hamaspik plan uses an established drug list (known as ‘The Formulary’) that has been approved by CMS (The Centers for Medicare and Medicaid Services). The drug list includes both brand name and generic drugs in all medication categories. Just speak with your doctor about the drugs you need, and show them the formulary for your plan.
MTMP Requirements
To be eligible for Hamaspik Medicare Choice (HMO D-SNP), individuals must meet the following criteria:
You have 3 or more of the following chronic illnesses:
- Alzheimer’s disease
- Diabetes Mellitus
- Dyslipidemia
- Hypertension
- Chronic Obstructive
- Pulmonary Disorder (COPD)
You take at least 5 ongoing medications to manage your chronic illnesses
You are likely to incur an annual cost of $4,376 or more for your prescription drugs (based on the cost of prescriptions you filled in the previous 3 months)
How MTMP Enrollment Works
Review
A key component of the program is the Comprehensive Medication Review (CMR), which you will complete with one of our pharmacists during a telephone consultation. The CMR typically takes between 15 and 30 minutes. During that time, the pharmacist will answer any questions you have about your medications, the best time to take them, and more.
Reflect
A written summary of the discussion will be sent to you within 14 days. The written summary will include a letter, personal medication list and medication action plan. We encourage members to bring these documents to their physician visits to discuss the information provided.
Resolve
If you are found to be eligible for the MTMP, you will be automatically enrolled in the program. If you do not wish to participate, notify us at any time by calling 1-800-424-9342, and we will remove you from the MTMP. Hours are 9:00am to 5:00pm, Monday to Friday.
Reevaluate
In addition to CMR, members who participate in MTMP will be included in various Targeted Medication Reviews (TMRs) conducted throughout the year on a quarterly basis. TMRs use pharmacy claims data to assess eligible members’ medication profiles for medication-related issues or gaps in care. Any recommendation that is identified through the TMR will be sent to your physician so they may assess it during your next visit.
Missing some paperwork?
Check out our Healthcare Resources Page,
or download the prescription form below:
Problem with your coverage?
If you have a concern about your healthcare or would like to file a complaint about your Hamaspik plan, please contact Member Services within 60 days of the problem. We want to understand your concerns and help you to resolve them. Depending on the situation, your case will be handled as a grievance, complaint, or as an appeal. You can file a grievance or complaint in writing, over the phone, via fax or email. You can find detailed information about grievances and appeals in your Member Handbook.
Hamaspik Choice
Attn: Grievances and Appeals
58 Route 59, Suite 1
Monsey, NY 10952
Fax: 1-845-503-0999
1-855-558-4642
For TTY/TDD services, call 711
You can also file grievances with DOH by calling 1-866-712-7197
Please contact Member Services if you would like to obtain information about the aggregate number of grievances, appeals and exceptions that have been filed with your Hamaspik healthcare plan.
What to expect
After you file a grievance, Hamaspik looks carefully into your case and will seek to resolve the problem right away. We will respond with the following:
- The person who is working on your complaint
- The contact information for this individual
- Any additional information we will need to investigate your complaint
The next steps
We will investigate your concern and will notify you of our decision within 30 days (or within 72 hours for expedited grievances). If we do not agree with some or all of your complaint or choose to dispute the issue, we will notify you. Our response will include reasons for this answer.
You will be informed on how to appeal a decision and will be provided any necessary forms. If we are unable to make a decision about your complaint due to missing information, we will also notify you.
If you are still dissatisfied after we review your grievance, you may file a grievance appeal. Please see your member handbook for more information about this.
Service authorizations
Hamaspik Choice makes a service authorization every time we decide what services are covered. You or your doctor can also contact us to request a coverage decision if you are unsure if a particular medical service is included in your plan. You may also appeal this determination.
How to appeal
To appeal a decision about your health care services, please follow these guidelines:
- File an appeal within 60 business days of receiving our decision
- File the appeal yourself or ask someone you trust to file the complaint on your behalf
- Make sure the complaint is made in writing (even if you initially call, you must follow up in writing)
Your first level appeal is reviewed by Hamaspik Choice. If our decision about your appeal is not totally in your favor, you have the right to request a Fair Hearing. A Fair Hearing is a second level appeal that is heard by an independent third party. We will send you a notice that explains how this process works
Alternative Options
If you are not satisfied with the services you have received from Hamaspik, you (or someone on your behalf) may submit a complaint with the New York State Department of Health by dialing 1- 866-712-7197.
If your service request has been denied, we also encourage you to contact Member Services. There are many times when a member may ask Hamaspik Choice to approve a treatment or service in the form of an exception request. To get approval, call 833-426-2774 or send your request in writing:
Hamaspik Medicaid Choice
Attn: Care Management
58 Route 59, Suite 1
Monsey, NY 10952
Participant Ombudsman
The Participant Ombudsman, called the Independent Consumer Advocacy Network (ICAN), is an independent organization that provides free ombudsman services to long term care recipients in the state of New York. You can get free independent advice about your coverage, complaints, and appeal options. They can help you manage the appeal process.
They can also provide support before you enroll in a MLTC plan like Hamaspik Choice. This support includes unbiased health plan choice counseling and general program related information.
Contact ICAN to learn more about their services
Getting help
For assistance with filing a coverage decision or grievance or appeal,
contact us. Your doctor, prescriber or lawyer can also submit a request on your behalf at any point in the appeals process. Alternatively, you may appoint a friend, relative or another representative via the Appointment or Representative form on our
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