OASAS COVID 19 Reimbursement Addendum

April 6, 2021

Yesterday we sent all members the document (attached) that was sent to a NYS Council member agency representative when she inquired with the OASAS PICM mailbox regarding the temporary Outpatient Minimum Duration reimbursement changes OASAS made last year to accommodate social distancing requirements.  Since then OASAS has tried to reassure providers that, although not yet officially approved by CMS, they have confidence the  changes will be approved by CMS.

See directly below for first notification from OASAS, dated July 6, 2020.

Yesterday, after I reviewed the document we sent you (attached) I spoke to Trisha Schell-Guy about it.  Trisha notes that OASAS is still awaiting SPA approval for the minimum duration changes.  OASAS wants to provide a level of comfort to providers and so they included the information on page 15 but providers should note that the changes are not ‘official’ until the SPA is approved.

Yes, this is confusing.  And OASAS sounds very confident that all will go smoothly on this front.  We just wanted to make sure you had all of the relevant information.

 OASAS.sm.Communications <OASAS.sm.Communications@oasas.ny.gov>
Sent: Monday, July 6, 2020 12:59 PM
Subject: Outpatient Medicaid Time Duration COVID Changes

July 6, 2020

Dear Providers,

You recently received notification from OASAS regarding Preliminary Guidance for Reopening.  Though OASAS continues to recommend Telepractice for the delivery of treatment services, we are aware that programs will gradually be re-introducing services delivered on site.

 As noted in the guidance providers need to continue weighing risk/benefit factors in determining what services to offer, and in what manner. To address the continuing need for Social Distancing during reopening, OASAS is temporarily reducing Medicaid reimbursement minimum timeframes for the following services:

Procedure Code Current Minimum Temporary Minimum
Group Counseling H0005/90853 60 minutes 50 minutes
Intensive Outpatient1Services S9480 3 hours per day 2 ¼ hours per day
Outpatient Rehab Half1,2Day H2001 2 hours per service date 1.5 hours per service date
Outpatient Rehab Half1,2Day H2036 4 hours per service date 3 hours per service date

Discrete services may also be used for reimbursement as long as the services support the level of care needs of those identified via the LOCADTR 3.0 as needing this level of care.

For Outpatient Rehab Services a group counseling session of 50 minutes will meet the OPR service requirement.

The temporary minimum duration will be effective starting on July 1, 2020 and will continue until the requirement for Social Distancing has been removed.

If you have further questions regarding this information please email the PICM Mailbox at PICM@oasas.ny.gov.