OASAS 819 & 820 Providers – Read This! Approved Managed Care Reimbursement for Part 820 Per Diem: both a temporary 10% increase AND reimbursement for Part 820 Reintegration element

June 2, 2022

The NYS Council has been engaged in focused advocacy efforts to assist our OASAS 819 and 820 provider members to secure additional resources for several years. Below is excellent news from the Office re: long awaited approvals from CMS.  Yay Team NYS Council!  We owe great thanks to our OASAS colleagues for persevering and getting it done.

From: OASAS.sm.Communications <OASAS.sm.Communications@oasas.ny.gov>
Sent: Thursday, June 2, 2022 1:00 PM
To: ‘ALL-PROVIDERS-L@LISTSERV.OASAS.NY.GOV‘ <ALL-PROVIDERS-L@LISTSERV.OASAS.NY.GOV>
Subject: Approved Managed Care Reimbursement for Part 820 Per Diem: both a temporary 10% increase AND reimbursement for Part 820 Reintegration element 

Dear OASAS Certified Part 820 and Part 819 Programs:  

Please see below/attached. Additionally a webinar will be scheduled late June/early July to discuss/respond to questions. In the interim, please send questions to the PICM mailbox at PICM@oasas.ny.gov

Background :

  • As previously  discussed with providers and plan –  plans were notified of enhanced FMAP rate changes for OASAS programs.
  • That notification included a paragraph/language providing advance notice of rate enhancement applicable to Part 820 programs  – pending approval.
  • See attached PDF titled “ 3 24 2022 Enhanced FMAP plan notification – final PDF”

Current status:

  • All required approvals have now been received to implement the eFMAP Part 820 rate per diems.

Next Steps :

A . Plan Notification :

  • Per the attached the State has notified the Plans that :
  • Effective immediately, all necessary approvals have been received to implement the Part 820 rate enhancements in managed care. Specifically:
    1. A new Part 820 service element that is new to managed care –  Residential Reintegration ( rate code 1146)

AND

  • A temporary 10 % rate increase for Part 820 stabilization and Rehabilitation.
  • For complete details , please see the attached  email titled “ Enhanced FMAP Part 820 Rate Per Diems”.
  1. Reintegration Programmatic Requirements to bill the Per diem  = 5 or more hours per week of on-site rehabilitative services
  • Reintegration Programmatic Requirements to bill the Per diem  = 5 or more hours per week of on-site rehabilitative services.
  • All new Reintegration programs will provide a plan for the provision of required services as part of the Part 820 application.
  • For those programs that operate a congregate and/or scattered setting reintegration element , if the program chooses to claim the per diem the program will be required to :
    • deliver the 5+ hours of service on site at the physical property / specific PRU  ( e.g. the individual’s apartment)
    • Existing congregate and/or scattered setting reintegration programs will be required to submit a plan that describes its approach for the provision of such services to ATAR / Regional office for review and approval .
  1. Provider Information for Part 820 Reintegration to Managed Care Plans : Please note that Medicaid FFS is not available at this time / Pending approval.

The tables below summarizes submission of claims to Managed Care Plan.  

  1. Part 820 reintegration claim components; and, 
  2. where to submit Part 820 reintegration claim.   Programs are strongly advised to review the attached document for comprehensive information on Part 820 service reimbursement.
Medicaid Claim Components for Part 820 Reintegration Treatment Per Diem
Item Requirements Notes:
Rate Code 1146 Existing programs:  The State will add rate code onto the program’s eMedNY profile. Programs will receive a DOH system generated letter.
New programs: State will add rate code upon completion / as part of the OASAS certification process.
CPT/ HCPCS code H2036  
Modifier HF Plans may not deny if program fails to include the modifier.
Revenue Code May include: 900; 902; 911, 914, 944, 945 1002 Not specifically assigned by state
Bill Type May include 731; 762; 763; 861; 086; 891 Not specifically assigned
Claim Form 837 i  
Category of Service(COS)  0268 Existing programs:  The State will add COS code onto the program’s eMedNY profile. Programs will receive a DOH system generated letter.
New programs: State will add COS to programs eMedNY file upon completion / as part of the OASAS certification process.
NYS Medicaid program MMIS number Required If the Part 820 program (or is larger program entity) is not enrolled in the New York State Medicaid Program or does not have an MMIS number, the Part 820 Reintegration program must enroll in the NYS Medicaid Program using the specific “OASAS Part 820 Residential Treatment Program” application available online athttps://www.emedny.org/info/ProviderEnrollment/OASAS/index.aspx
Where to submit the Medicaid Part 820 Reintegration Treatment per diem claim:
  Requirements Notes
Medicaid Managed Care:  The program MUST submit the claims to the plan if the service recipient is / was enrolled in a Managed Care Plan on the date of service   For individual ‘s in receipt of Part 820 reintegration service retroactive to date of services 11/1/2021 Submit Part 820 reintegration claims to the Medicaid managed care enrollee’s plan. Plans are State directed to waive any timely filing requirements for the retroactive claims.  Programs are responsible for contacting the managed care plans toinitiate / ensure it is contracted / credentialed with the managed care plan to deliver Part 820 reintegration services to plan enrolleesANDconfigured in the plan’s claims configuration system. Plan Contact information may be found at the CTAC Matrix. 
Medicaid FFS Pending approval