More info re: OASAS Rate Increases

February 27, 2023

Last week we were pleased to inform all NYS Council members about rate increases for a variety of OASAS Programs and Services.  As we stated previously, the funds for these increases come from state enforced MCO recoupments for Behavioral Health Expenditure Targets that were not met by certain MCOs.  The NYS Council knew that the state had failed to enforce the targets and recoup the funds that were (in essence) overpayments to MCOs. The funds belong to OASAS and OMH and we were determined to ensure they were returned to the agencies. Our advocacy resulted in $37M being returned to OASAS for the current budget year, with another $37M proposed to be returned to OASAS in the executive budget that came out last month.  Similarly, OMH received $74M for each of the same two years, and the Office has already delivered rate increases to a variety of OMH programs and services.  

In addition to the two year period (discussed above), the state will now be required to enforce the targets on an annual basis and show its efforts to retrieve recoupments on its website, to include the names of the plans that missed their targets which are included in their contracts to ensure they spend the majority of the funds they receive by the state on actual care for Medicaid beneficiaries. 

Here’s the rate change information we shared with all members last week.  Note: Last Wednesday, we sent you a copy of the NYS Register Public Notice regarding the Part 820 increases:

– 5% trend on every Medicaid-able OASAS service except hospital inpatient (Jan 1):

– off-site rate code enhancement for freestanding outpatient and OTP (Jan 1)

– Peer weight increase (Jan 1)

– Addiction Specific E&M APG weight increases (Jan 1)

– Part 820 Residential Rate Increases (March 1)

– Investment in Center of Excellence in coordination with OMH

-additional efforts OASAS hopes to make public shortly.

So here’s the reason for all this detail:

Late last week a NYS Council member asked a question after reading the Public Notice in the NYS Register that we sent to all members, about the Part 820 rate changes:

Here is the question:  

Is the 15.0% increase for Stabilization and 4.5% increase for Rehabilitation for downstate providers only?

The answer from OASAS is:  The 5.6% is just for downstate stabilization.  On top of that, the 15.0% and 4.5% are state wide increases.

Please feel free to reach out with any questions or concerns and remember:  #NYSCouncilAdvocacyWorks!