September 5, 2023

As you will recall, the recently enacted state budget included two provisions impacting children’s services and specifically, school-based mental health services provided by OMH Article 31 Satellite Clinics:
1)  Increases APG Medicaid rates paid to Article 31 school-based MH satellite clinics by as much as 25%;2)  Requires commercial insurers to pay school-based MH clinic providers the Medicaid rate for services provided to their beneficiaries who are receiving school-based MH services.

Regarding the rate increases (#1 – discussed above) OMH prepared and submitted a draft SPA to DoH (SPA #2368) for DoH review and approval.  DoH is currently going through final review and then it will be submitted to CMS (most likely the last week of September).  

Other state actions:  A Public Notice on the proposed action was published in the NYS register on 3/29/23 and the state updated the APG grouper in July to prepare for this change.  The state is likely to go ahead and implement this provision (once DoB approves the rate changes) even if it does not yet have CMS approval.  

The next step for OMH and DOH is to issue guidance on the budget action to include formal notice to MCOs re: the rate changes, allowing MCOs time to re-configure their technology.  Guidance expected in ‘very near future’.  Increased rates are effective July 1, 2023.

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Regarding #2 (above)

The commercial fee schedule for commercial insurers will be ready in the very near future.  OMH is working with DFS re:  use of the APG grouper (DFS has no prior experience with this technology), and OMH is drafting guidance for plans and providers, along with the flat fee schedule.  This budget provision is effective January 1, 2024.  OMH will need to give adequate notice to the commercial insurers, and to providers.   Statewide fee schedule should be out at the end of October.