October 28, 2025

When members of the NYS Council’s Billing Geeks group met last Wednesday for our weekly meeting, several participants reported having recently received overpayment notices from (insurer) Molina stating the plan is implementing Medicaid Utilization Thresholds (MUTS) (30/50 price reductions) on mental health services provided by its in network OMH Article 31 providers for services rendered to its Medicaid members.  Importantly, OMH billing guidance only speaks to implementation of Medicaid Utilization Thresholds on Fee for Service claims.  Molina does not manage FFS reimbursement for our service.  As such, we have notified OMH of this issue.

As always, the NYS Council is on this.  If you receive a recoupment letter from an MCO for services you provided to a Medicaid member with Medicaid managed care coverage and it is based on the implementation of the 30/50 visit UR pricing reductions, please let me know at your earliest convenience.  Stand by for more.