August 30, 2024
Since early May, the NYS Council has been pushing relentlessly on state leaders to get guidance out the door to providers re: Part AA – the commercial rate mandate that we secured as part of the FY25 enacted state budget. Our efforts include numerous meetings with the Governor’s Office, communications with the Department of Financial Services (regulates commercial insurance in NYS) and lots of advocacy directed at OMH and OASAS. But to this point the state has not put out anything written that clarifies or answers questions from providers about the newly enacted provision. As such, the NYS Council has tried to provide clarity to members based on our discussions with state agency leads.
We anticipate that within the next week or so providers will receive written information from OMH and OASAS regarding Medicaid benchmark rates that will serve as the floor for your future reimbursement for services provided to New Yorkers with commercial insurance (excluding those that are covered by self-funded policies). As I understand it you will also receive hundreds of rate codes for a broad range of programs and services that can draw down the mandated commercial rate. Finally, we anticipate the state will eventually share a provider specific compendium of rates based on the programs and services you operate that are covered under the commercial mandate.
The Department of Financial Services along with OASAS and OMH intend to issue FAQs in response to the questions providers have sent to the state agencies and DFS re: Part AA. The NYS Council has (based on member feedback) raised 5 critical questions/concerns that should generate written responses from state leaders. It does not sound as if DFS is going to issue a formal circular to insurance plans re: Part AA although we know DFS leaders have met with them re: Part AA. OMH and OASAS intend to hold a Webinar for impacted providers re: Part AA, and OMH has established a commercial mailbox where you can submit questions re: Part AA: commercial-billing@omh.ny.gov OMH is also contemplating a Helpline to ensure providers get the assistance they need as the new provision takes effect on Jan. 1, 2025 and beyond (depending on when the contract or policy between the health plan and the employer who is purchasing the policy to cover its employees is executed, renewed, amended, etc.).
In related news, neither OASAS or OMH have issued formal COLA rate notices for the increases that passed as part of the April 2024 enacted state budget. I am currently chasing the package of rates that typically goes from desk to desk downtown, pushing for expedited approvals and loading of rates at DoH.
The good news is that we have been pushing hard and now have a commitment from state leaders to quickly implement last year’s COLA for HealthHome+ providers who have not yet received last year’s COLA. Our Billing Geeks group got us involved in this issue about 6 weeks ago and we have been assertively pushing the relevant state agency leaders re: their responsibility to get the money out the door to impacted providers.
If you have questions or concerns please do not hesitate to reach out to me at 518 461-8200 or lauri@nyscouncil.org. We are always here to help.