Note: This information is for NYS Active, PA and PE enrollees of The Empire Plan.
What is HCAP?
The Empire Plan covers skilled nursing services, infusion therapy, certain durable medical equipment and other supplies at home through the Home Care Advocacy Program (HCAP), allowing you to receive medical care right where you live. HCAP can:
- Arrange skilled nursing services and infusion therapy at home
- Obtain certain durable medical equipment (e.g., nebulizers, wheelchairs) and supplies
- Cover diabetic and ostomy supplies
Prior Approval
To receive covered services in your home at no cost to you, call HCAP for prior approval. If you don’t call HCAP for prior approval, or if you use a non-approved provider:
- Your provider may require payment in full upfront
- You may need to submit your own claim
- Your benefits are reduced to a non-network level (50% of the HCAP network allowed amount, subject to deductible)
Get Started
After a provider prescribes skilled nursing services, medical equipment or supplies at home:
- Call The Empire Plan at 1-877-769-7447. Press or say 1 for the Medical/Surgical Program, then 3 for HCAP. Representatives are available weekdays, 8 a.m. to 4:30 p.m., ET. Voicemail is available 24/7.
- An HCAP representative will work with you and your provider to determine coverage and medical necessity.
- HCAP will arrange care with an approved provider.
