November 22, 2022

In April 2022, the NYS DOH issued New York State Medicaid Update – April 2022 Volume 38 – Number 4, including “Medicaid Enrollment Requirements and Compliance Deadlines for Managed Care Providers.” The update specifies that both participating and non-participating Medicaid Managed Care providers must enroll as a Medicaid provider to comply with Section 5005(b)(2) of the 21st Century Cures Act and Section 1932(d) of the Social Security Act. The State has received multiple inquiries from MMCPs and providers regarding the applicability of these requirements to behavioral health provider types, including agencies and individual practitioners, who are either non-enrollable or newly eligible to enroll in the State’s Medicaid program. The purpose of this memo is to provide additional guidance to MMCPs regarding reimbursement for behavioral health services.

MMCPs are required to continue to reimburse for behavioral health services provided by licensed, certified, or designated OMH or OASAS programs, including services provided by behavioral health practitioner types that are currently not eligible to enroll in the Medicaid Program, such as Mental Health Practitioners licensed pursuant to Article 163 of the Education law. Until such time as additional provider types are eligible to enroll in the State’s Medicaid program, OMH and OASAS providers have been instructed to follow state-issued guidance regarding the attending and referring fields on Medicaid claims.

OMH and OASAS provider claims that comply with these requirements should be reimbursed without regard to whether the practitioner who actually provided the service is enrolled in the Medicaid program. Additionally, OMH and OASAS designated providers of Adult Behavioral Health Home and Community Based Services (BH HCBS) and Community Oriented Recovery and Empowerment (CORE) Services are newly eligible to enroll in the Medicaid program. The State is actively working with several BH HCBS and CORE providers to complete Medicaid enrollment. To allow the necessary time for these providers to enroll and to ensure the continuity of care of members receiving BH HCBS and CORE Services, MMCPs must:

• Timely process and reimburse claims submitted by BH HCBS and CORE providers, including claims for services rendered by practitioners who are not currently eligible to enroll in the Medicaid program, and

• For program or practitioner types not enrollable as of September 1, 2022: Not take any adverse action, such as removal from the network for failure to demonstrate Medicaid enrollment on September 1, 2022, and

• For any new, or newly eligible for Medicaid enrollment, behavioral health
  programs or practitioners types: Reimburse, for at least 120 days, any providers while Medicaid makes its enrollment decision on pending enrollment applications.

MMCPs must follow this guidance for individual behavioral health practitioners, BH HCBS, and CORE providers, until further notice by NYS.

Questions can be directed to bho@omh.ny.gov.

1 A list of Medicaid-enrollable provider types can be found on the eMedNY Provider Enrollment and Maintenance webpage (see right side panel labeled “Provider List Filter”).

2 Guidance for Article 31 clinics is available at Attending Referring Guidance – July 24, 2020 (ny.gov); guidance for Children and Family Treatment and Support Service (CFTSS) and Children’s Home and Community Based Services (HCBS) Providers is available at Medicaid Provider Enrollment for Individual
Practitioners and Designated Agencies (ny.gov).