April 18, 2024

One document attached

Good morning,

First and for those who missed our Thursday call this morning, I want to update you on what we know so far about the coming (new) state budget.  Scrolling downwards, please find a Notice to health plans from OMH and OASAS regarding the APG changes to group therapy services that I discussed on our call this morning and previewed for all members over the weekend.  

BUDGET TIMING:

Yesterday the Legislature passed yet another budget extender that keeps our state government running through 11:59 pm tomorrow (April 19).  This could indicate lawmakers plan to print and pass all of the remaining bills by Saturday, although it is also possible that they will do another budget extender tomorrow night if the work is not complete.

List of budget bills that have printed so far and are now available to the public is quite limited.  There are a total of 10 bills that  must be printed and passed by both the Assembly and the Senate before moving on to the Governor for final action:

PUBLIC PROTECTION GENERAL GOVERNMENT (PPGG)
AB 8805-C / SB 8305- C
TRANSPORTATION/ENVIRONMENT 
AB 8808-C / SB 8308-C
REVENUE 
AB 8809-B / SB 8309-B

FOLLOWING IS INFO WE ARE WAITING TO CONFIRM WITH OUR OWN EYES IN FINAL BUDGET BILLS:

COLA (pending confirmation) Yesterday we sent you DRAFT language that would set the Human Services COLA for eligible agencies at 2.84%.  However, as the DRAFT info shows, the funds are split:1.5% flexible 1.7% restricted  (Excludes certain CFR codes for c-suite execs)

Commercial Rate Mandate (pending confirmation) We have been informed by several sources that the enacted budget will include a provision requiring commercial payers to reimburse OMH & OASAS outpatient services (Article 31, Article 32) at least the Medicaid rate.  We are waiting to confirm in printed budget documents.

Telehealth Payment  (pending confirmation) Budget extends law that requires payment parity between FTF and telehealth services for an additional 2 years – 2026. Unclear whether FQHCs have been added to list of provider types that can count on parity between these two modalities (FTF vs. telehealth)We still need to see all of this in writing.

OMIG Reform – (pending confirmation) Budget unlikely to include OMIG Audit Reform per our legislation.

DFS COMMERCIAL ENFORCEMENT FINES 
Budget appears to omit an executive proposal that would have increased fines on commercial insurers for non-compliance with parity mandates or failure to self-assess compliance according to requirements set forth by NYS.  Waiting to confirm this in budget bills.

HOSPITAL RATE INCREASE (pending confirmation) We have heard persistent rumors that the enacted budget will include a 3.5% increase for hospitals and nursing homes. We are waiting to confirm this in budget bills.

MEMORANDUM

TO:               Mainstream Medicaid Managed Care Plans, Health and Recovery Plans (HARPs), HIV Special Needs Plans (HIV SNPs), and Medicaid Advantage Plus (MAP) Plans

FROM:            New York State (NYS) Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS)

DATE:             April 18, 2024

SUBJECT:      Mandated Rate Update: APG Rate Changes for Psychotherapy (Group and Family Group) and Peer Support Services

Dear Health Plan Administrators,

Effective January 1, 2024 and July 1, 2024 the Psychotherapy (Group and Family Group) and Peer Support service rates will be adjusted, consistent with the State Fiscal Year (SFY) 2023-2024 and 2024-2025 Enacted State Budget, as outlined below. This letter is being sent to alert Mainstream Medicaid Managed Care Plans, Health and Recovery Plans, HIV Special Needs Plans, and Medicaid Advantage Plus Plans (collectively referred to as “MMCPs” herein) of the adjustments to ensure compliance with the statutorily required payment of government rates.

Please refer to the CPT Procedure Weight and Rate Schedule (Rows 30-32) on the OMH Fiscal/Billing Resources page and the OASAS Ambulatory Providers page for the services below.

1. Effective January 1, 2024: APG Rate Updates for OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Programs Only

1. Psychotherapy – Group 1 hour (Procedure Code: 90853): service weight was temporarily increased by 50%.

2. Psychotherapy – Family Group 1 hour (Procedure Code: 90849): service weight will increase by 50%.

3. Self-help/peer services – Group 15 minutes (H0038-HQ): service weight will increase by 50%.

2. Effective July 1, 2024: APG Rate Updates for OMH MHOTRS and OASAS Programs

1. Psychotherapy – Group 1 hour (Procedure Code: 90853) 
   1. The service weight for OASAS programs will increase by 30%, and
   2. The service weight increment for OMH MHOTRS will be adjusted from 50% to 30% of the original weight (.3207) that was in effect prior to January 2024. This will align OMH programs’ service weight with OASAS programs and broaden the number of OMH and OASAS providers eligible to receive the enhancement for group psychotherapy.

2. Psychotherapy – Family Group 1 hour (Procedure Code: 90849): service weight will increase by 50% for OASAS programs and will continue for OMH MHOTRS programs.

3. Self-help/peer services – Group 15 minutes (H0038-HQ): service weight continues to receive the 50% increase for OMH MHOTRS Programs only.  OASAS only allows individual peer services and, thus, does not utilize the Self-help/peer services group modifier.

4. For both OMH and OASAS programs: Billing 90853 and 90849 with modifiers AF (psychiatrist), AG (physician), or SA (psychiatric nurse practitioner) will continue to increase the weight for the group service by an additional 20%.

5. For OASAS programs only: The provider will be required to code one of the three modifiers listed above or one of the following three modifiers; AH (clinical psychologist), AJ (clinical social worker), or HO (master’s level), when submitting claims for 90853 or 90849 in order to receive the enhancements mentioned in #1 and #2 above.

Note: Failure by an OASAS provider to code one of these six (6) modifiers with 90853 or 90849 will result in a payment based on a weight of .3207 without any enhancements.

NOTE: Procedure Code H0005, Alcohol and/or drug services – group counseling by a clinician, is used for all group services provided by non-licensed staff in OASAS programs, and its APG weight remains unchanged at .3207.

The table below explains the rate adjustments outlined above.  Additionally, all of these changes have been, or will be, built into the applicable version of the 3M APG grouper-pricer. 

Please note that this document is only being transmitted electronically. No hard copy will be forthcoming.

If you have any questions regarding these rate changes, please contact OMH Managed Care at 518-402-2822 or BHO@omh.ny.gov.

Thank you.

Office of Mental Health
Division of Managed Care
44 Holland Avenue, Albany, New York 12229
bho@omh.ny.gov