September 26, 2025
This morning I sent all NYS Council members (and our Billing Geeks listserv participants) a copy of the communication OMH recently sent to all insurers required to begin paying Medicaid reimbursement rates that reflect the recently enacted (2025) Targeted Inflationary Increase (COLA) at 2.6%. DoB has approved the rates and insurers are now on a clock to begin paying the rate as required by law. For your convenience, OMH communication to MCOs, etc. is pasted below.
At the same time I reached out to OASAS and received the following information from Deb Davis, OASAS CFO a moment ago, fyi:
OASAS submitted a notification to DOH to be released to the plans. This happened just a few moments ago. As a next step, we will be releasing a similar notification to our providers. See attached OASAS Plan Notification.
Also, we have posted the rates at the OASAS reimbursement site. The following links have also been updated – see below:
- OASAS Part 816 Article 32 Medically Supervised Inpatient Withdrawal (Rate Code 4220)
- OASAS Part 818 Article 32 Inpatient Rehabilitation (Rate Code 4213)
- OASAS Part 818 Article 32 OASAS State Operated Addiction Treatment Centers (Rate Code 4202)
- OASAS Part 817 Residential Rehabilitation for Youth (Rate Code 4210)
Hope this helps everyone.
OMH 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) |
| Date: | September 25, 2025 |
| Subject: | Rate Approval: April 2025 Cost of Living Adjustment (COLA) – Notification of Division of Budget (DOB) Approval |
Dear Health Plan Administrators,
On July 1, 2025, OMH notified Mainstream Medicaid Managed Care Plans, HARPs, HIV SNPs, and MAP Plans (collectively referred to as “MMCPs” herein) of increases to mental health outpatient service rates to reflect a legislatively mandated 2.6 percent COLA (also noted as Targeted Inflationary Increase (TII) in the State Fiscal Year (SFY) 2025-26 enacted budget) effective April 1, 2025. This memorandum is being sent to alert MMCPs that DOB approved the rate increase for the COLA (TII) on September 9, 2025.
Per Chapter 57 of the Laws of 2022 and Chapter 451 of the Laws of 2019, MMCPs are required to pay claims based on the effective date of the rate changes. As a result, MMCPs must complete necessary system edits to ensure payable claims with dates of service on or after April 1, 2025, for applicable OMH programs are reimbursed accurately and timely, as described in the July 1, 2025, memorandum. Additionally, MMCPs are required to conduct retrospective reconciliation to adjust payments for clean claims as necessary. MMCPs must complete these activities as soon as possible, but no later than 90 days from the date of this notification, December 24, 2025.
[1] The April 1, 2025, COLA (TII) increase for Children’s Home and Community Based Services (HCBS) is pending DOB approval at this time. For more information, please go to the NYS Department of Health (DOH) HCBS Provider Manuals and Rates webpage.
Please refer to the OMH Medicaid Reimbursement Rates webpage for the applicable services that get the COLA (TII) increase and the April 1, 2025 Rate Update for COLA (TII)[1] for the original notification distributed to MMCPs.
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
Strategic Finance and Managed Care