July 18, 2024

JUNE MEDICAID UPDATE

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the June 2024 Medicaid Update. Please find the improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at: https://health.ny.gov/health_care/medicaid/program/update/2024/docs/mu_no6_jun24.pdf. A print-ready version is also available on the Medicaid Update web page.

You may also go straight to an article or topic that pertains to you by selecting from the current issue’s table of contents below.

Policy and Billing

• Clarification: Coverage of Licensed Mental Health Counselor and Licensed Marriage and Family Therapist Services Provided in Article 28 Outpatient Hospital Clinics and Free-Standing Diagnostic and Treatment Centers (Cover)
• Submission of Prenatal and Postpartum Service Claims for Each Pregnancy Related Visit

All Providers

• Reminder: Licensed Providers Must Enroll with New York State Medicaid to Serve Medicaid Members

Pharmacy

• Attention Pharmacy Providers: Cold Storage Requirement

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POLITICO, 7/17/24

Most New Yorkers with depression receive no counseling or medication, according to a new data brief by New York City’s Department of Health and Mental Hygiene.

Among adults who reported frequently experiencing depressive symptoms, 41 percent received mental health treatment in the past year, the department found.

Twenty-seven percent of adults with depression reported needing treatment at some point in the last 12 months but did not get it, according to the analysis, which is based on the department’s 2022 community health survey.

Unmet mental health treatment needs were more prevalent among younger adults and non-white New Yorkers.

Meanwhile, rates of depression were highest among adults ages 18 to 24, multiracial New Yorkers and adults who identify as bisexual.

Prevalence of depression was also associated with financial distress, stressful or traumatic events and chronic health conditions, such as hypertension and asthma.

“These findings indicate the need for routine depression screening and improved access to mental health care, particularly for adults at increased risk of depression,” the data brief states.

The Health Department noted it is working to increase access to mental health care by advocating for policies that reduce financial barriers.

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Politico, 7/17 – Note this article focuses on (federal) Medicare telehealth policy.  Obviously there are implications for Medicaid telehealth policy too although it is important to remember that individual states have far more control of (state) Medicaid telehealth policy.  Here in NY, a bill that continues the broad use of telehealth services in healthcare settings is set to expire in April 2025 after advocates (including the NYS Council) pushed out the sunset of this policy from 2024 to 2025 during the budget negotiations process.  And while OMH and OASAS mental health and substance use disorder providers are currently reimbursed for telehealth services at the face-to-face rate, other types of providers (FQHCs, etc) have fought to be added to the list of provider types that are covered by this requirement but to this point FQHCs have not been added to that list.

Congress is taking its time to decide whether Medicare should permanently pay for telehealth.

The Bipartisan Policy Center says that’s a mistake. The think tank’s new policy report advises legislators to adopt a long-term Medicare and Medicaid reimbursement strategy that gives providers reason to invest in the service.

“The potential problem there is telehealth providers and investors won’t have that certainty needed to make long-term investments in telehealth infrastructure to support continuing to integrate telehealth into our larger health care system,” Maya Sandalow, senior policy analyst at the center, told Ruth.

Extending the temporary telehealth rules adopted during the Covid pandemic, which are set to expire at the end of the year — and seems to be the most likely scenario — also perpetuates standards that made sense then but don’t now.

For example, telehealth is reimbursed at the same rate as in-person visits under current rules. In some cases, such as mental health appointments, parity might make sense. But in other cases, it might incentivize providers to offer only virtual care, even when in-person care is needed, the report says.

The Bipartisan Policy Center thinks Congress needs to consider a more nuanced reimbursement model that accounts for how telehealth care is delivered, such as via a quick email or a full video appointment. The policy paper suggests Congress consider bundling payments to account for short follow-up interactions related to an initial visit.

Why it matters: Telehealth is an important facet of medical care, allowing patients to see doctors despite travel limitations and offering physicians an opportunity to connect with patients outside of traditional appointments.

However, it needs to be funded.

What’s next? While telehealth policy languishes in Congress, some states are setting their own, creating inconsistent rules nationwide.

Private insurers are also setting their own reimbursement policies — often offering less than what they would pay for an in-person visit.

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Attention PROS Programs

On April 16, 2024, OMH notified Mainstream Medicaid Managed Care Plans, HARPs, HIV SNPs, MAP Plans and PROS providers (SEE ATTACHED DOCUMENT) of programmatic and reimbursement changes for OMH PROS programs. This memorandum is being sent to alert MMCPs and PROS providers that DOB approval was received on June 27, 2024 and the PROS programmatic and reimbursement changes will be effectuated on November 1, 2024.

Please note: Guidance documents, additional information regarding the redesign implementation plan, and other resources will be distributed shortly. Programs are encouraged to attend the regional PROS provider forums for up-to-date information on implementation.

For questions, please contact the Rehabilitation and Treatment Services Unit at PROS@omh.ny.gov

Thank you,

The Bureau of Rehabilitation, Treatment, and Care Coordination

Office of Mental Health

44 Holland Avenue

Albany, NY 12229

——————————From: CORE-Services <CORE-Services@omh.ny.gov>
Date: Tue, Jul 16, 2024 at 12:18 PM
Subject: MCO-Identified Adult BH HCBS and CORE Services Best Practices
To: <HCBS-L@listserv.omh.ny.gov>

Hello,

During the Adult BH HCBS Infrastructure Program, HARPs and their contracted Infrastructure providers worked to increase HARP member access to, and utilization of, BH HCBS and CORE Services. Some HARPs and providers jointly developed innovative solutions to engage HARP members, expedite the BH HCBS and CORE Services workflow, and address barriers to receiving BH HCBS and CORE Services.

As requested during individual HARP quarterly Infrastructure calls, the State previously compiled a list of Adult BH HCBS best practices identified by HARPs through the Infrastructure Program. The attached list was updated to include CORE Services best practices identified by HARPs through the Infrastructure Program Extension.

This document does not contain new State policy. It highlights innovative practices some HARPs are implementing at different points in the Adult BH HCBS and CORE Services workflow to support engagement in, and access to, BH HCBS and CORE Services.

Please contact bho@omh.ny.gov with questions.