October 21, 2025

At the beginning of the month, BH providers contracted with Fidelis for Medicaid managed care services received a notice from Fidelis stating that, beginning 11/1 Fidelis will be requiring prior authorization for certain MH and SUD therapy codes beyond 24 units.  The Update was also listed on the Fidelis Website.  The NYS Council immediately contacted state officials regarding our numerous concerns with this new mandate, and a day or two later Fidelis sent an Updated Notice to its in-network providers stating that the requirements for the impacted Family Psychotherapy and Group Psychotherapy codes were effective for requests over 30 units (rather than 24 units of service listed as the threshold in the first Fidelis notification).

In our view, continuity of care for the New Yorkers we serve is under siege while Fidelis introduces new UMR requirements seemingly with little to no oversight by state regulators.  In addition, we are deeply concerned that there appears to be no proactive and ongoing surveillance, monitoring and (where appropriate) enforcement in these instances.  As such we have been very assertive in our many communications with state officials on this matter.

This morning Fidelis again updated its Provider Notice on this matter (on its Website) as follows: Updated Guidelines: Group and Family Therapy Authorization Process, Effective 11/1/25, Excludes Substance Use Disorder (SUD) Treatment. | Fidelis Care.  THE NOTICE ONLY APPLIES TO SUD TREATMENT SERVICES and is based on OASAS insurance reforms that were implemented over a decade ago.

Of course the new requirement still presents major problems for many reasons and as such we will not stop fighting.  Having said this we have to take the partial wins where we can get them.  OASAS acted quickly upon our having reported this latest Fidelis overreach to the Office a few weeks ago, and we are grateful for their leadership on this matter.

On Monday night the NYS Council made a formal (written) request of NYS to order Fidelis to put this new requirement on hold until such time as all outstanding issues and concerns are resolved. Obviously the request no longer applies to OASAS SUD services but OMH services are still caught in the eye of this storm.

I know you will agree that none of this is in any way acceptable.  As such, the NYS Council continues to intensify our advocacy, and will continue to do so in the days to come.

Stand by for more to follow.

#NYSCouncilAdvocacyWorks! (and keeps working until the job is done)