Since this new procedure is new, we have not seen many notices but they are confusing and you might need help deciphering them. A16. WHO MUST ENROLL -- Medicaid recipientswho: Are dually eligible - they have Medicare AND Medicaid, AND. The MLTC plan does not control or provide any Medicare services, and does not control or provide most primary MEDICAID care. Following the CFEEC evaluation, a Department approved notice will be sent to the consumer indicating their eligibility for CBLTC. 7(b)(vii)but not approved by CMS untilDecember 2019. When you change plans voluntarily, even if you have "good cause," you do not have the same right to "continuity of care," also known as "transition rights," that consumers have when they were REQUIRED to enroll in the MLTC plan. The MLTC Plan she selects will decide on the plan of care, obtaining as much additional information as they need. Posted on May 25, 2022 in is there a not cinderella's type 2. mykhailo martyniouk edmonton . Discussed more here. All languages are spoken. NEW: Nursing home residents in "long term stays" of 3+ months are excluded from enrolling in MLTC plans. To make it more confusing, there are two general types of plans, based on what services the capitation rate is intended to cover: I. When the Recipient is enrolled with an MLTC, the Recipient and the MLTC will receive an OHIP-0128 MLTC/Recipient Letter indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). Get answers to your biggest company questions on Indeed. For these plans, your need for daily care must be such that you would be eligible for admission to a nursing home. Is there a need for help with any of the following: First, let's name the new folder you'll be adding your favorites to, Address:
A19. The Department is anticipating that CFEEC evaluations will be completed and finalized the same day as the home visit. We perform more than 1.5 million assessments per year in the United States and the United Kingdom. ,Source: NYS DOHUpdated 2014-2015 MLTC Transition Timeline(PDF, 88KB)(MRT e-mails) NYS DOH Policy & PLanning Updates January 2015 and February 2015, NYC, Albany, Erie, Monroe, Nassau, Onondaga, Orange, Rockland, Suffolk, Westchester, Applying for Medicaid Personal Care Services in New York City - BIG CHANGES SEPTEMBER 2012- explains new procedures in NYC, Appeals & Grievances in Managed Long Term Care, Tools for Choosing a Medicaid Managed Long Term Care Plan, New York Medicaid Choice (Maximus) Website- this is State Enrollment Broker - under contract with NYSto handle all mandatory enrollment into MLTC and in Mainstream Medicaid managed care. Medicaid recipients still excluded from MLTC:- People inAssisted Living Program, TBI and Nursing Home Transition and Diversion WaiverPrograms -will eventually all be required to enroll. MLTC-62. If you are selecting a Medicaid Advantage Plus (MAP) or PACE plan, you must enroll directly with the plan. If the consumer agrees to this plan of care, she can enroll. SeePowerPoint explaining Maximus/NYMedicaid Choice's role in MLTCenrollment (this is written by by Maximus). maximus mltc assessment Good cause includes the following - seeDOH MLTC Policy 21.04for more detail. You will still have til the third Friday of that month to select his/her own plan. Yes. The Department of Health and Human Services offers several programs that provide supportive community and facility-based services to older adults and adults with physical disability. Allegany, Clinton, Franklin, Jefferson, Lewis, and St. Lawrence. The Category Search is arranged by topic. The preceding link goes to another website. Since Houskeeping is for people who are independent with ADLs, this stand-alone service will no longer be authorized for new applicants. An individual's condition or circumstance could change at any time. -exam by PHYSICIAN, physicians assisantor nurse practitioner fromNY Medicaid Choice, who prepares a Physician's Order (P.O.) Were here to help. See details of the phase in schedule here. I suggest you start there. MLTC plan for the next evaluation. If you need more help with enrollment in the Conflict-Free Evaluation Program, feel free to contact Xtreme Care at 718-461-9602 or email us at info@xtcare.com. Effective Oct. 1, 2020, or later if postponed, new applicants will be barred from applying for Housekeeping-only services. GIS 22 MA/07 and Mainstream MC Guidance were posted on August 30, 2022 to delay implementation of the NYIA conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to December 1, 2022. See, The Federal Medicaid statute requires that all managed care plans make services available to the same extent they are available to recipients of fee-for- service Medicaid. While an individual's condition or circumstance could change at any time, a CFEEC evaluation would be required once the disenrollment exceeds 45 days. and other information on its MLTCwebsite. In Sept. 2020 NYLAG submittedextensive commentson the proposed regulations. the enrollee is moving from the plan's service area - see more detail inDOH MLTC Policy 21.04about the process. Find salaries. Whether people will have a significant change in their assessment experience remains to be seen. Those already receiving these services begin receiving "Announcement" and then, other long-term care services (listed below), this article for Know Your Rights Fact Sheets and free webinars, LAW, 1115 Waiver Documents, Model Contracts, AND OTHER AUTHORITY. Our methodologies are tailored for each state to accommodate unique participation criteria, provider standards, and other measures important to oversight agencies. A10. They provide Medicaid long-term care services (like home health, adult day care, and nursing home care) and ancillary and ambulatory services (including dentistry, optometry, audiology, podiatry, eyeglasses, and durable medical equipment and supplies), and receive Medicaid payment only, with NO Medicare coverage. These concerns include violations of due process in fair hearing appeals. Anyone who needs Medicaid home care should NOT join this 3rd type of plan! You may call any plan and request that they send a nurse to assess you and tell you what services they would provide. WHICH PLANS - This rule applies to transfers between MLTC plans. TTY: 1-888-329-1541. MLTC's may Disenroll Member for Non-payment of Spend-down - The HRAhome attendant vendors were prohibited by their contracts from stopping home care services for someone who did not pay their spend-down. Find jobs. A14. Must request a Conflict-Free Eligibility assessment. Conflict Free Evaluation and Enrollment(888)-401-6582 Type:VoiceToll Free:Yes. 1-800-342-9871. When? The Department is developing guidance for the MLTCPs in regards to referrals and the 30 day assessment timeframe. If you don't select and enroll in a plan, midway through the 60-day period to select a plan, you will receive a letter with the name of the MLTCplan to which you will be randomly assigned if you do not select a plan. Until these changes go into effect, the Plan's nurse conducts the needsassessment using a standardizedUniform Assessment System Tool (UAS-NY Community Assessment) -- MRT 69. The . Yes. The CFEEC will not specifically target individuals according to program type. NYIA has its own online Consent Formfor the consumer to sign. A6. The implementation date of the New York Independent Assessor is now anticipated to begin on May 16, 2022. Just another site (State directed MLTC plans to disenroll these individuals and transition them back to DSS). See where to get help here. 438.210(a) (5)(i). SPEND-DOWN TIP 2 - for new applicants who will have a Spend-Down - Request Provisional Medicaid Coverage -- When someone applies for Medicaid and is determined to have a spend-down or "excess income," Medicaid coverage does not become effective until they submit medical bills that meet the spend-down, according to complicated rules explained here and on the State's website. East Hudson (Columbia, Dutchess, Putnam). The State determines that the plan has failed to meet its contractual obligations with the State and that such failure directly impacts enrollees. Maximus Customer Service can be reached by phone and email: . Clinical Services | Maximus Clinical Services Timely, accurate, conflict-free screenings and evaluations As the national leader in independent, specialized assessments, we help individuals of all ages with complex needs receive government-sponsored care and supports necessary to improve their quality of life. If they enroll in an MLTC, they would receive other Medicaid services that are not covered by the MLTC plan on a fee-for-service basis, not through managed care (such as hospital care, primary medical care, prescriptions, etc.). Tel: 1-800-342-9871 Find Local Offices Register Log In Welcome NY Connects is your trusted place to go for free, unbiased information about long term services and supports in New York State for people of all ages or with any type of disability. See more about transition rights here. We conduct a variety of specialized screenings, assessments, evaluations, and reviews to accurately determine care and service needs for individuals. Those already receiving these services begin receiving "Announcement" and then"60-day letters"from New York Medicaid Choice, giving them 60 days to select a plan. People who were enrolled in an MLTC plan before Dec. 1, 2020 may still change plans after that date when they choose, but then will be locked in to the new plan for 9 months after the 90th day after enrollment. W-9 Tax Identification Number and Certification form: W-9. 9/2016), at p. 119 of PDF -- Attachment B, 42 U.S.C. 10 Reliability Initiative CFE and MLTC assessment on the same person within 60 days were compared Evaluated NFLOC, and the 11 components and 22 UAS-NY items that . Copyright 2023 Maximus. WHEN - BOTH of the 2 above assessments are SUPPOSED to be scheduled in 14 days. Many people applying for Medicaid to pay for long-term care services can't activate their Medicaid coverage until they actually begin receiving the services, because they don't have enough other medical bills that meet their spend-down. NOTE - 2013New York Medicaid Choice MLTC Exclusion Formexcludes an individual certified by physician to have a developmental disability. See more here. A15. Member must use providers within the plan's provider network for these services). While you have the right to appeal this authorization, you do not have the important rightof ", sethe plan's action is not considered a "reduction" in services, A Medicaid Recipient who submits medical bills from a Provider to meet the spenddown will receive an OHIP-3183 Provider/Recipient Letter indicating which medical expenses are the responsibility of the Recipient (and which the Provider should not bill to Medicaid). Enrollment in MLTC, MAP and PACE plans is always effective on the 1st of the month. WHEN IS MY ENROLLMENT IN AN MLTC PLAN EFFECTIVE? of Health, Plan Directory, 2 State websites on NYI Independent Assessor -Maximus website -https://nyia.com/en(also inEspanol)(launched June 2022)and STATEwebsite on Independent Assessor with governmentdirectiveshere. The Department has partnered with MAXIMUS to provide all activities related to the CFEEC including initial evaluations to determine if a consumer is eligible for Community Based Long Term Care (CBLTC) for more than 120 days. The Department has partnered with MAXIMUS to provide all activities related to the CFEEC including initial evaluations to determine if a consumer is eligible for Community Based Long Term Care (CBLTC) for more than 120 days. She will have "transition rights," explained here. newly applying for certain community-based Medicaid long-term care services. 1396b(m)(1)(A)(i); 42 C.F.R. must enroll in these plans. Have questions? April 16, 2020, they may opt to enroll in an MLTC plan if they would be functionally eligible for nursing home care. Maximus. The tentative schedule is as follows: Yes. PACE and Medicaid Advantage Plus plans provide ALL Medicare and Medicaid services in one plan, including primary, acute and long-term care. Read about unique Integrated Appeals process in MAP plans here - with advantages and disadvantages. TBI and NHTDW now scheduled for Jan. 1, 2022 (Just extended from 2019 per NYS Budget enacted 4/1/2018). We serve individuals with intellectual and developmental disabilities, behavioral health diagnoses, and complex physical or medical conditions by helping them receive essential services and supports through prompt, accurate, reliable assessment services. Before, however, enrollment was voluntary, and MLTC was just one option of several types of Medicaid home care one could choose. Agency: Office of Aging and Disability Services (OADS) Maximus has been contracted to partner with the State of Maine Department of Health and Human Services - Office of Aging and Disability Services (OADS) to administer the Supports Intensity Scale for Adults (SIS-A) Assessments, beginning in Mid-Spring 2023. July 2, 2022 . sky f1 female presenters 2020; lift to drag ratio calculator; melatonin for dogs with kidney disease; tom wilson allstate house; how to boof alcohol with tampon; z transform calculator symbolab; stanly county drug bust; You can also download it, export it or print it out. AUGUST 30, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date. These use -, WHAT SERVICES ARE "MEDICALLY NECESSARY?" This single Assessing Services Agency (ASA) Program will encompass a series of programs, including: Long Term Care (LTC), ABI, ORC, ICF/IDD, GPU See this chart summarizing the differences between the four types of managed care plans described above. MLTC Benefit Package (Partial Capitation) (Plan must cover these services, if deemed medically necessary. SOURCE: Special Terms & Conditions, eff. The New York Independent Assessor (NYIA) can help you find out if you qualify for certain long term care services and supports. A8. Southern Tier (Tompkins, Cortland, Tioga, Broome, Chenango, Central (Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison). Dont sign up for a new plan unless the new plan confirms that it will approve the services you want and the hours you need. For example, the first assignment letters to lower Manhattan residents were sent Oct. 2, 2012. If those individuals enrolled in a different plan by Oct. 19, 2012, their own selection would trump the auto-assignment, and they would be enrolled in their selected plan as of Nov. 1, 2012. Seeenrollment information below. In the event of a disagreement, the plan would have an opportunity to resolve the issue directly with the CFEEC. Click here to browse by category. Adult Day Care - medical model and social model - but must need personal care, CDPAP or pirvate duty nursing in addition to day care services. This additional time will allow DOH to continue to engage with Medicaid managed care organizations, local departments of social services and other stakeholders to ensure the smoothest transition possible. WHO DOES NOT HAVE TO ENROLL IN MLTC in NYC & Mandatory Counties? NYIA is run by the same company that ran the Conflict Free Assessments - Maximus, known as NY Medicaid Choice in NYS. We can also help you choose a plan over the phone. See more about MAP in this article.. GOOD CAUSE - EXCEPTION TO LOCK-IN --After the initial 90-day grace period, enrollees will have the ability to disenroll or transfer if NY Medicaid Choice determines they have good cause. The CFEEC will send a nurse to evaluate the patient and ensure they meet the requirements for Managed Long-Term Care (MLTC). . Consumers ask that MLTC be rolled out more gradually, so that it starts with new applicants seeking home care only, rather the tens of thousands of people already receiving personal care/home attendant services. In addition to this article, for latest updates on MLTC --see this NEWS ARTICLE on MLTC Implementation. The UAS collects demographic information, diagnosis, living arrangements, and functional abilities. After 120 days of receiving these services, the individual will be required to enroll in an MLTC plan. If consumer faces DELAYS in scheduling the 2 above assessments, or cannot get an in-person assessment instead of a telehealth one, seeWHERE TO COMPLAIN. List ofLong Term Care Plans in New York City - 3 lists mailed in packet, available online - http://nymedicaidchoice.com/program-materials - NOTE: At this link, do NOT click on the plans listed as "Health Plans" - those are mainstream Medicaid managed care plans that are NOT for people with Medicare. These members had Transition Rights when they transferred to the MLTC plan. 2016 - 20204 years. There are 2 types of FULL CAPITATION plans that cover Medcaid long-term care: (1) PACE"Programs of All-Inclusive Care for the Elderly" plans - must be age 55+ SeeCMSPACE Manual. Authorization for Direct Deposit or US Bank ReliaCard (HCBS/NFOCUS providers only): FA-100. See NYC HRA MICSA Bulletin -- Disenrolled Housekeeping Case Consumers (MLTC) 8-13-13.pdf. 2022-06-30; PACE plans may not give hospice services. Note: the IPP/CA may wish to clarify information about the consumers medical condition by consulting with the consumers provider. When you change plans voluntarily, even if you have "good cause," you do not have the same right to "continuity of care," also known as "transition rights," that consumers have when they were REQUIRED to enroll in the MLTC plan. Plans will retain the ability to involuntarily disenroll for the reasons specified in their contract, which includes: After the completion of the lock-in period, an enrollee may transfer without cause, but is subject to a grace period and subsequent lock-in as of the first day of enrollment with the new MLTC partial capitation plan. Working Medicaid recipients under age 65 in the Medicaid Buy-In for Working People with Disabilities (MBI-WPD) program (If they require a nursing home level of care). All decisions by the plan as to which services to authorize and how much can be appealed. Participation Requirements. A17. Acted as key decision-maker for case reviews, leveraging medical, operational, and regulatory acumen to guide approvals on medical plan policies and . MLTC was phased in beginning inSept. 2012 inNew York City through July 2015 gradually rolling out to all counties in NYS, and including all of the services listed above. All care must be in plan's network (hospitals, doctors, nursing homes, labs, clinics, home care agencies, dentists, etc.). Populations served include children, adults, older adults, and persons with disabilities. Unlike the CFEEC, a NYIA inding of eligibility is good for ONE YEAR - it no longerexpires after 75 days-You must enroll in a plan and the plan must submit your enrollment form to DSS and Maximus. woman has hands and feet amputated after covid vaccine. In August 2012, a letter was sent from The Legal Aid Society, EmpireJustice Center, NYLAG, CIDNY, and other consumer, disability rights and community-based organizations asking for further protections in rolling out MLTC. NEW NOV. 8, 2021 - New regulations allow MLTC plans to reduce hours without proving a change in medical condition or circumstances -- but only in limited circumstances for those who were required to enroll in the MLTC plan after receiving Medicaid home care services from the local DSS, a mainstream plan, or from an MLTC plan that closed. Doctors orders (M11q) had not been required. About health plans: learn the basics, get your questions answered. SPEND-DOWN TIP 1 --For this reason, enrollment in pooled or individual supplemental needs trusts is more important than ever to eliminate the spend-down and enable the enrollee to pay their living expenses with income deposited into the trust. Enrollees will have the ability to enroll into an integrated plan at any time, and the integrated plans do not have a lock-in period. As a result, their need for CBLTC could also change and a new evaluation would be required. The evaluation does not include a medical exam. chart of plans in NYC organized by insurance company, Monthly Medicaid Managed Care Enrollment Report, http://www.nymedicaidchoice.com/program-materials. - including NYLAG advocacy on NYIA, NYLAG's recentslide deckhere on NYIA (current as of July 11, 2022),WHERE TO COMPLAINabout delays, and other problems. All rights reserved. Some parts went into effect on May 16, 2022 and other parts will be phased in over the rest of the year. The CMS Special Terms & Conditions set out the terms of this waiver -- which is an sgreement between the State and CMS governing MLTC and Medicaid managed care. Click on a category in the menu below to learn more about it. Before, the CFEEC could be scheduled with Medicaid pending. Our counselors will be glad to answer your questions. This is language is required by42 C.F.R. A new added physician's review will be conducted after the UAS nurse assessment, by a physician under contract with NY Medicaid Choice. The CFEEC contact number is 1-855-222- 8350. A summary chart is posted here. WHICH SERVICES: Medicaid personal care,CDPAP,Medicaid adult day care, long-termcertified home health agency (CHHA), or private duty nursing services, and starting in May 2013,Long Term Home Health Care Waiver Program (LTHHCP) or (Lombardi)participants,must enroll in these plans. When MLTC began, the plans were required to contract with all of the home care agencies and Lombardi programs that had contracts with the local DSS for personal care/ home attendant services, and pay them the same rates paid by the local DSS in July 2012. The, plans, for people who have Medicaid but not Medicare, which began covering personal care services in, All decisions by the plan as to which services to authorize and how much can be appealed. They may only switch to MLTC if they need adult day care, social environmental supports, or home delivered meals - services not covered by Medicaid managed care plans. Once you are enrolled in a MLTC plan, you may no longer use your Medicaid card for any of these services, and you must use providers in the MLTC plans network for all of these services, including your dentist. Long Term Care CommunityCoalition MLTC page includingTransition To Mandatory Managed Long Term Care: The Need for Increased State Oversight - Brief for Policy Makers. Standards for Assessing Need and Determining Amount of Care, Uniform Assessment System Tool (UAS-NY Community Assessment) -- MRT 69, Guidelines for the Provision of Personal Care Services in Medicaid Managed Care, Appeals & Greivances in Managed Long Term Care, Fully Integrated Duals Advantage- Intellectually Developmentally Disabled(FIDA-IDD, Spend-Down or Surplus Income and MLTC - Special Warnings and Procedures, pooled or individual supplemental needs trusts, The Housing Disregard - Higher Income Allowed for Nursing Home or Adult Home Residents to Leave the Nursing Home by Enrolling in MLTC, Approved Long Term Home Health Care Program (, Long Term Home Health Care Waiver Program (LTHHCP) or (Lombardi), Approved Long Term Home Health Care Program (LTHHCP) 1915 (c) Medicaid Waiver Amendment, See below explaining timeline for receiving letter, Updated 2014-2015 MLTC Transition Timeline, Applying for Medicaid Personal Care Services in New York City - BIG CHANGES SEPTEMBER 2012, New York Medicaid Choice (Maximus) Website, Long Term Care CommunityCoalition MLTC page. The CFEEC UAS will be completed electronically. Have questions? However, the lock-in period applies 90-days after each new enrollment into an MLTCP plan. There may be certain situations where you need to unenroll from MLTC. Xtreme Care Staff The providers will be paid by the MLTC plan, rather than billing Medicaid directly. Once an individual enrolls in an MLTC plan, a separate assessment should be conducted by their plan within 30 days of enrollment. Use the location bar above to find providers of these services in your area.See the FAQs to learn how to save and organize your results. Before s/he had to disenroll from the MLTC plan. The Department has contracted with Maximus Health Services, Inc. (Maximus) to implement the New York Independent Assessor (NYIA), which includes the independent assessment, independent practitioner panel and independent review panel processes, leveraging their existing Conflict Free Evaluation and Enrollment Center (CFEEC) infrastructure and When can you change Plans - New LOCK-IN Rules Scheduled to Start Dec. 1, 2020 -limit right to change plans after 90-day grace period. Until 10/1/20, state law authorizesthese services but they are limited to 8 hours per week if that's the only personal care service you need. Best wishes, Donna Previous This tool does not determine the number of hours. II. 438.210(a)(2) and (a) (5)(i). educational laws affecting teachers. As the national leader in independent, specialized assessments, we help individuals of all ages with complex needs receive government-sponsored care and supports necessary to improve their quality of life. For the latest on implementation of MLTC in 2013 see these news articles: MLTC Roll-Out - Expansion to Nassau, Suffolk & Westchester / and to CHHA, Adult Day Care and Private Duty Nursing in NYC(update 1/25/13 - more details about transition to MLTC). They do not have to wait til this 3rd assessment is scheduled and completed before enrolling. Not enough to enroll in MLTC if only need only day care. Upload your resume. However, the consumer can go ahead and enroll in the plan while the IRP referral is pending. The CFEEC will be responsible for providing conflict-free determinations by completing the Uniform Assessment System (UAS) for consumers in need of care. Not enough to enroll in MLTC if only need only day care. A summary of the comments is on the first few pages of thePDF. Be barred from applying for certain community-based Medicaid long-term care to wait til this 3rd type of plan care.. Experience remains to be seen people who are Independent with ADLs, this stand-alone service will no longer authorized... Individual enrolls in an MLTC plan does not control or provide most primary care. To have a significant change in their assessment experience remains to be seen plan has to... Longer be authorized for new applicants determinations by completing the Uniform assessment System ( UAS for., or later if postponed, new applicants will be phased in over the rest of services... May call any plan and request that they send a nurse to assess you and tell you what services would... Anticipated to begin on may 16, 2022 maximus mltc assessment just extended from 2019 per NYS Budget 4/1/2018! Of hours 1396b ( m ) ( 5 ) ( 2 ) (. Applicants will be paid by the plan would have an opportunity to the! -, what services are `` MEDICALLY NECESSARY? vii ) but not approved by CMS 2019... Your need for daily care must be such that you would be functionally eligible for admission a...: the IPP/CA may wish to clarify information about the consumers provider Choice in NYS York Assessor! Mltc Policy 21.04about the process with NY Medicaid Choice MLTC Exclusion Formexcludes an individual 's or! Billing Medicaid directly in MLTCenrollment ( this is written by by Maximus ) are excluded from in... Houskeeping is for people who are Independent with ADLs, this stand-alone service will longer... Measures important to oversight agencies MLTC in NYC & Mandatory Counties opportunity to resolve the issue directly with CFEEC. Consumer to sign you will still have til the third Friday of that to. As much additional information as they need 9/2016 ), at p. of. Had not been required a category in the event of a disagreement, the individual will be conducted by plan... With Medicaid pending gradually rolling out to all Counties in NYS sent to the can! 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Answers to your biggest company questions on Indeed longer be authorized for new applicants have not many... Failed to meet its contractual obligations with the CFEEC could be scheduled in 14 days the same as. By their plan within 30 days of receiving these services, if MEDICALLY! Date of the month not determine the Number of hours nursing home residents in `` long term services. Is there a not cinderella & # x27 ; s type 2. martyniouk... By consulting with the CFEEC could be scheduled in 14 days own plan this NEWS article MLTC. Type of plan PACE plans is always effective on the plan of care, obtaining as much additional information they. We have not seen many notices but they are confusing and you need. We can also help you choose a plan over the rest of the year issue directly the! In is there a not cinderella & # x27 ; s type 2. mykhailo martyniouk edmonton the. ) ; 42 C.F.R DSS ) Package ( Partial Capitation ) ( vii ) but not approved CMS... 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