November 22, 2024

The information below may be helpful to your agency as you continue to prepare for implementation of Part AA – the new commercial rate mandate.  

As we told all members several weeks ago, OMH was (at that time) developing granular rate information to assist providers and to ensure health plans have the information they need to comply with the new law that takes effect January 1, 2025 and upon contracting, re-contracting or amending existing contracts between the commercial insurer and the employer.   Reminder:  If the policy is self-funded the new commercial rate mandate does not apply. 

Take a look and let me know what additional information would be useful.  

Remember:  CCBHC Demo agencies are reimbursed utilizing a PPS rate methodology rather than APG methodology.  On the other hand, CCBHC Expansion Grant agencies are reimbursed for Medicaid services based on APG rate methodology.  

This is the info you are looking for on the OMH Commercial Billing page:

Exhibit E – MHOTRS APG OMH Outpatient Fee Schedule(November 18, 2024)
Contains fee schedules for OMH outpatient services applicable to Part AA that are priced using APG methodology. This document can be used to determine the final price for every MHOTRS outpatient behavioral health service billed by an OMH-licensed provider, according to Peer Group.

From: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Sent: Friday, November 22, 2024 12:18 PM
To: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Subject: Additional Resources for Implementation of January 1, 2025 Commercial Rate Mandate

Dear Health Plan Administrators and Providers,

This email announces changes to the Commercial Billing for Behavioral Health (BH) Services webpage and newly added resources to support commercial insurers and providers with system configurations. Users will find a suite of resources under the headings “Commercial Billing Guidance & Resources” and “Fee Schedules & Rate Tools.”

Notable Fee Schedule resource added:

Exhibit E – MHOTRS APG OMH Outpatient Fee Schedule (November 18, 2024)

Contains fee schedules for OMH outpatient services applicable to Part AA that are priced using APG methodology. This document can be used to determine the final price for every MHOTRS outpatient behavioral health service billed by an OMH-licensed provider, according to Peer Group.