September 30, 2024
From: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Sent: Monday, September 30, 2024 4:08 PM
To: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Subject: January 1, 2025 Commercial Rate Mandate – Frequently Asked Questions
Dear Health Plan Administrators and Providers,
Part AA of Chapter 57 of the Laws of 2024 (“Chapter 57”) takes effect on January 1, 2025 and requires New York State-regulated insurers to reimburse in-network providers licensed by the Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) at or above the Medicaid rate for outpatient behavioral health services. Please see attached for answers to Frequently Asked Questions (FAQ) regarding the scope and implementation of Chapter 57.
This FAQ will also be added to the Commercial Billing for Behavioral Health (BH) Services (ny.gov) webpage under the heading “Commercial Billing Guidance.”
Please be advised that OMH is working with our State Partners at OASAS and DFS to develop educational opportunities to support providers and commercial insurers as they prepare for the implementation of Chapter 57.
Sincerely,
OMH Commercial Billing
From: omh.sm.commercial-billing
Sent: Monday, September 23, 2024 4:26 PM
To: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Subject: Additional Resources for Implementation of January 1, 2025 Commercial Rate Mandate
Good afternoon,
In follow up to our September 10, 2024 notice (see below), 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 heading “Commercial Billing Guidance.” Resources include:
Contains provider-specific APG Base Rates (including School-Based Mental Health Clinic services), with associated rate codes.
For Commercial Plans listing possible combinations of procedures, modifiers, and other elements to determine the final APG weight.
- Exhibit C – Non-APG OMH Outpatient Services Fee Schedule (previously announced 9/10/24 under the title Commercial Fee Schedule for non-APG OMH-licensed Outpatient Services)
Contains fee schedules for OMH outpatient services applicable to Part AA that are not priced using APG methodology. Includes: applicable rate codes, procedure codes, modifiers and units of service.
Contains provider-specific rates for non-APG OMH outpatient services applicable to Part AA.
The above fee schedule resources supply rate information for insurers to identify minimum in-network reimbursement requirements for services provided by OMH and OASAS facilities, so long as those services are already covered by fully insured commercial plans.
Part AA applies to fully insured individual and group comprehensive health insurance policies and contracts issued in New York. Part AA does not apply to self-funded coverage.
The Commercial Billing for Behavioral Health (BH) Services webpage also now includes a new heading for “School-Based Mental Health Clinic Resources,” which houses all previously issued information relevant to commercial billing, including the School-Based Mental Health Clinic Program Site List.
Please note, additional resources and educational opportunities related to the scope and applicability of Part AA are forthcoming.
Sincerely,
OMH Commercial Billing
From: omh.sm.commercial-billing
Sent: Tuesday, September 10, 2024 10:54 AM
To: omh.sm.commercial-billing <commercial-billing@omh.ny.gov>
Subject: Resource for Implementation of January 1, 2025 Commercial Rate Mandate
Good morning,
Under the 2025 New York State Enacted Budget, and in accordance with Part AA of Chapter 57 of the Laws of 2024, effective on or after January 1, 2025, commercial insurers will be required to reimburse covered outpatient mental health and substance use disorder services provided by in-network OMH and OASAS facilities at rates that are not less than the Medicaid rates for those services.
To assist with the implementation of this mandate, NYS has established a Commercial Billing for Behavioral Health (BH) Services webpage. This page provides rate and reimbursement information as well as interpretive support resources.
This email serves as notification of a newly added Commercial Fee Schedule for non-APG OMH-licensed Outpatient Services, to support commercial insurers and providers with system configurations. This workbook provides benchmark rates for OMH outpatient services, excluding APG rates for Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) providers, to represent minimum reimbursement standards, applicable to Part AA, and provides additional resources to support commercial insurers in complying with the reimbursement mandate.
Best,
OMH Commercial Billing
Office of Mental Health
Division of Managed Care