November 8, 2021
|To:||New York State Medicaid Managed Care Plans (MMCPs), HIV Special-Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs)|
|From:||New York State Department of Health (DOH); Office of Mental Health (OMH)|
|Date:||November 08, 2021|
|Subject:||Minimum Wage Increase Effective January 1, 2022|
Dear Health Plan Administrators:
Effective January 1, 2022, mental health outpatient provider rates will be increased to reflect legislatively mandated increases in minimum wage. This letter is being sent to alert all Medicaid Managed Care Plans (MMCPs) (including Health and Recovery Plans and HIV Special Need Plans) of behavioral health outpatient rate increases and to ensure compliance with the statutorily required payment of government rates.
Rate tables with rate changes for the below services are located on the OMH Medicaid Reimbursement Page: https://www.omh.ny.gov/omhweb/medicaid_reimbursement/.
- Assertive Community Treatment (ACT)
- Personalized Recovery Oriented Services (PROS)
- Article 28 and 31 Continuing Day Treatment (CDT)
- Partial Hospitalization
- OMH-licensed Article 31 Mental Health Clinics Reimbursed under APG Methodology
Additional rate enhancements for Federal Medical Assistance Percentage (FMAP) will be forthcoming.
The rates, which are reflected in the premiums, will be effective January 1, 2022. For mental health clinics, the new rates will be loaded into the 3M Grouper Pricer. For all other outpatient mental health services, the changes to the rate schedules will be posted to the OMH website.
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 January 1, 2022, and thereafter are reimbursed at the newly effective rates. MMCPs are required to conduct retrospective reconciliation to adjust payment for claims as necessary within 90 days of receipt of this notification.
Please note that this document is only being transmitted electronically. No hard copy will be forthcoming.
If you have any questions regarding these changes, please contact OMH Managed Care staff at 518-408-2822 or BHO@omh.ny.gov
Office of Mental Health
Division of Managed Care
44 Holland Avenue, Albany, New York 12229
Feeling stressed by the COVID-19 pandemic? You are not alone. Call the NY Project Hope Emotional Support Helpline 7 days a week, 8am-10pm at 1-844-863-9314 or visit https://nyprojecthope.org
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