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Effective June 13,2011 the Albany-based Maximus Enrollment Center (ENR), doing business as New York Health Options, will assume responsibility for administering the recertification process for most Upstate Medicaid cases. Initial eligibility determinations will continue to be administered by the local social services districts.
Pursuant to 18 NYCRR 358-4.3(c) (1), the Maximus Enrollment Center can request a waiver of personal appearance and submit to this office, prior to the hearing date, a waiver request and evidentiary packet. Waiver requests will be reviewed and granted on a case-by-case basis. At this time, "blanket" waivers of appearance will not be granted; however, if the Maximus Enrollment Center does not receive a telephone call from this office prior to the hearing date indicating otherwise, it will be presumed that a waiver has been granted.
Even in situations where a waiver of appearance has been granted, the Administrative Law Judge may require the testimony of a Maximus Enrollment Center representative at the time of the hearing. It will, therefore, be necessary that a primary contact person be available (and a back-up contact be designated to be available) during the course of the hearing to accept a telephone call from the Administrative Law Judge. The primary and back-up contact persons' name and telephone number should be included on the request for waiver. The waiver request should also contain the fair hearing number, and a summary of the specific facts relevant to the issue under review at the hearing. A proposed format for requesting a waiver of appearance is attached as an example.
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