Breaking News: NY Files 1135 federal waiver request

March 24, 2020

Thanks to all those who attended this morning’s NYS Council conference call designed to assist our members as they continue to manage through the COVID-19 crisis.  We’ll be hosting another call on Thursday morning from 9:15-10:00.  Use the call in information distributed in previous emails to access the call.  If you need the call in info just ask Cindy for it:

One of the discussions we had this morning was based on my initial briefing where I discussed our intelligence that NY would soon be filing a waiver with the federal government seeking increased flexibility for Medicaid providers in order to help mitigate the losses you continue to sustain while also seeking direct funds to further behavioral health providers.

The information below is an excerpt from the 1135 waiver New York filed with the federal government this week.  The entire document can be found at the link here:

“…Additionally, New York seeks authority under its State Plan, to the extent it does not already exist, to amend the Medicaid reimbursement for services delivered by community based mental health service providers. This waiver is required due to State mandates to minimize face-to-face contact and slow the spread of COVID-19. Accordingly, it is not possible for community based mental health providers to continue to provide site-based services under existing minimum contact standards or for the required minimum durations for the duration of the emergency. Currently, outpatient and rehabilitation behavioral health services are reimbursed under various federally approved methodologies which include monthly case payment, per diem, and per visit bases for claiming. In order to alleviate the immediate fiscal impacts associated with lost revenues and ensure community provider access and continuity of patient care during and after this crisis, the State requests authority to modify or eliminate contact standards within the following Medicaid services:

  • Outpatient Clinic;
  • Outpatient Rehabilitation;
  • Opioid Treatment Programs;
  • Peer Services;
  • Medically Supervised Outpatient Withdrawal;
  • Residential Rehabilitation Service for Youth;
  • Residential Rehabilitation (Adults);
  • Medically Supervised Residential Withdrawal;
  • Assertive Community Treatment;
  • Rehabilitative Services for Residents of Community-based Residential Programs;
  • Personalized Recovery Oriented Services;
  • Day Treatment services for Children;
  • Continuing Day Treatment;
  • Partial Hospitalization;
  • Mental Health Clinic and Outpatient Hospital Services; and
  • Children’s EPSDT services including Other Licensed Professional, Crisis Intervention,
    Community Psychiatric Supports and Treatment, Psychosocial Rehabilitation Services, Family Peer Support and Services, and Youth Peer Support and Training services.

“For the duration of the nationwide public health emergency, the State requests a waiver to modify or eliminate the minimum number of contacts required to submit claims for payment, shorten or eliminate the duration of minimum service encounters, and modify patient service plans in response to COVID-19. In addition, through this 1135 Waiver request or another waiver authority, such as Appendix K under a 1915(c) Waiver, New York seeks to reimburse providers for rehabilitative services to residents of community residents during a period of non-residence due to COVID-19. Similarly, to the extent the State determines that a provider of any of the services above cannot provide any services, including telephonic services, due to mandatory program closures due to COVID-19, the State requests authority to reimburse providers of such services.”

Questions?  Call Lauri at 518 461-8200.