September 21, 2023
Finally here is the information we’ve been waiting for regarding rate increases that are happening in the OASAS service delivery system. We’ve been talking about these increases for what seems like forever, eagerly anticipating formal notice of the fruits of our labor.
As you know, significant portions of the increases discussed here are funded as result of MCO recoupments the NYS Council went after back in 2020 when we learned that MCOs were being permitted to hold on to funds considered to be overpayments due to their not having met certain expenditure targets for spending on actual care for Medicaid recipients, as required by their contracts with the state.
Hooray!
#NYSCouncilAdvocacyWorks!
OASAS
Dear Provider,
The New York State Division of Budget recently approved rate increases for OASAS Certified Treatment Providers.
The attached document was sent to the Medicaid Managed Care Plans notifying them of the changes and the expectation for reimbursement.
- MMC Plans have up to 90 days from the notification letter to update their systems with the rate changes.
- With the exception of Services in the Community plans are required to provide the additional reimbursement without further action of the providers.
Providers are encouraged to:
- Review the attached document which explains the rate increases and gives the effective date(s).
- Reach out to their plan representatives for status on system reconfiguration.
- Keep a spreadsheet of the impacted claims for any future reimbursement issues.
- Utilize the In Community Services Rate Codes, 1080 Outpatient Clinic/Rehab, or 1088 for OTP’s for any services that are provided outside of the clinic setting.
- Identify claims dating back to January 1, 2023, for services provided in the community. Those claims will need to be adjusted with the appropriate rate code for the additional retroactive rate amounts.
If you have further questions please email PICM@oasas.ny.gov
Thank you,
Communications Department
NYS Office of Addiction Services and Supports (OASAS)