July 8, 2022
Last night a NYS Council member agency representative asked me about why certain children’s services are not included in the Notice (below and attached) everyone received from OMH yesterday. Great question! Certain children’s services (and their corresponding rates) are regulated by the Department of Health and not OMH. That means the rate setting for these services are DoH’s purview. As such, the OMH Notice to the Plans that was circulated yesterday does not discuss CFTSS and HCBS services. Instead, you will find Notice of rate changes for these services on the DoH website here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/proposed_spa.htm
The updated rate information on the DoH website serves as official notice to the plans regarding the rate changes for these services. At the link, click on “RATES” and you will see a drop down with recently updated rates.
On the same DoH webpage, if you look to the left column and click on the ‘1915(C) Children’s Waiver and 1115 Waiver’ box, and then click on ‘Children’s Waiver Manuals and Rates’ and then click on “Rates” you will see updated info re: HCBS rates for these services. This posting services as official notice to the plans regarding these specific rate changes.
Here is also a helpful link that will help children’s service providers:
New York State Children’s Medicaid System Transformation (ny.gov)
If you need me call me at 518 461-8200 anytime!
———- Forwarded message ———
From: Lauri Cole <firstname.lastname@example.org>
Date: Thu, Jul 7, 2022 at 7:32 PM
Subject: Fwd: FW: April 2022 Cost of Living Adjustment
See below and attached.
So, Plans are now on notice: “Per Chapter 57 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 systems edits to ensure payable claims for dates of service April 1, 2022, and thereafter are reimbursed at the newly effective rates and are required to conduct retrospective reconciliation to adjust payment for claims as necessary within 90 days of receipt of this notification.”
From: OMH Managed Care Providers <PROVIDERS@LISTSERV.OMH.NY.GOV> On Behalf Of Buckley, Shannon (OMH)
Sent: Thursday, July 7, 2022 3:48 PM
Subject: FW: April 2022 Cost of Living Adjustment
To: Mainstream Medicaid Managed Care Plans (MMCPs), Health and Recovery Plans (HARPs), and HIV Special Needs Plans (HIV SNPs)
From: New York State Office of Mental Health (OMH)
Date: July 7, 2022
Subject: April 2022 Cost of Living Adjustment
Dear Health Plan Administrators,
The mental health outpatient service rates, which will be reflected in the premiums upon State and Federal approvals, have been increased to reflect a legislatively mandated increase in the Cost-Of-Living Adjustment (COLA) effective April 1, 2022. This letter is being sent to alert Medicaid Managed Care Plans (MMCPs), including Mainstream Medicaid Managed Care Plans, Health and Recovery Plans, and HIV Special Needs Plans, of the adjustments to ensure compliance with the statutorily required payment of government rates.
Please refer to the OMH Medicaid Reimbursement Page: https://www.omh.ny.gov/omhweb/medicaid_reimbursement/ for the below services with rate updates.
• Assertive Community Treatment (ACT)
• Continuing Day Treatment (CDT)
• Non-State Operated Continuing Day Treatment (CDT)
• Comprehensive Psychiatric Emergency Program (CPEP)
• Partial Hospitalization (PH)
• Personalized Recovery Oriented Services (PROS)
• OMH-licensed Article 31 Mental Health Clinics Reimbursed under APG Methodology
• Community Oriented Recovery and Empowerment (CORE) Services
• Adults Behavioral Health Home and Community Based Services (BH HCBS)
• Mobile Crisis Services for children under 21 years old
• Crisis Residential Services for children under 21 years old1
Per Chapter 57 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 systems edits to ensure payable claims for dates of service April 1, 2022, and thereafter are reimbursed at the newly effective rates and are required to conduct retrospective reconciliation to adjust payment for claims as necessary within 90 days of receipt of this notification.