September 22, 2022
The NYS Division of the Budget (DOB) has approved the OMH Outpatient Clinic rate changes for the February 2022 5% increase, and the Workforce Recruitment and Retention 11.5% (temporary) increase (effective 2/1/22-9/30/22). The State will be loading this information into eMedNY shortly and funds will flow retroactive to effective dates. MCOs have been notified. See below transmittal, dated 9/1/2022 that was sent to all MCOs.
As the Notice (below) states: ” Per Chapter 57 of the Laws of 2019, MMCPs are required to pay claims based on the effective date of the rate changes. As a result, MMCPs must complete necessary systems edits to ensure Article 31 Mental Health Clinic are reimbursed at the newly effective rates as listed above and are required to conduct retrospective reconciliation to adjust payment for claims as necessary within 90 days of receipt of this notification.”
Please share this information with your staff who are responsible for chasing MCO full and timely reimbursement. They will appreciate it!
Lauri
From: omh.sm.co.bho
Sent: Thursday, September 1, 2022 4:15 PM
To: omh.sm.co.bho <bho@omh.ny.gov>
Subject: Article 31 Mental Health Clinic eFMAP Rate Increase Notification
MEMORANDUM
To: Mainstream Medicaid Managed Care Plans (MMCPs), Health and Recovery Plans, and HIV Special Needs Plans
From: New York State Office of Mental Health (OMH)
Date: September 1, 2022
Subject: Article 31 Mental Health Clinic eFMAP Rate Increase Notification
Dear Health Plan Administrators,
The Article 31 Mental Health Clinic rates, which will be reflected in the premiums upon State and Federal approvals, will be increased to reflect an 11.5 percent Workforce Recruitment and Retention (R&R) Enhancement and the expenditure of the funds generated by the 5 percent increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures provided by Section 9817 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2)[1].
This letter is being sent to alert Medicaid Managed Care Plans (MMCPs), including Mainstream Medicaid Managed Care Plans, Health and Recovery Plans, and HIV Special Needs Plans, of the adjustments to ensure compliance with the statutorily required payment of government rates. Rates for Article 31 Mental Health Clinic are being increased based on models developed by the Office of Mental Health (OMH).
Please refer to the OMH Medicaid Reimbursement Page: https://www.omh.ny.gov/omhweb/medicaid_reimbursement/ which has been updated for
Article 31 Mental Health Clinic with rate enhancements effective February 1, 2022 and October 1, 2022[2].
Please note the rates on the Medicaid Reimbursement Page incorporate all the following adjustments (including enhancements and reductions) into one rate for reimbursement to the provider(s).
- 02/01/2022 rate includes the following adjustments:
- eFMAP HCBS 11.5% workforce R&R enhancement
- eFMAP HCBS program ongoing 5% enhancement
- 10/01/2022 rate includes the following adjustments:
- eFMAP HCBS 11.5% workforce R&R enhancement removal
- eFMAP HCBS program ongoing 5% enhancement
Per Chapter 57 of the Laws of 2019, MMCPs are required to pay claims based on the effective date of the rate changes. As a result, MMCPs must complete necessary systems edits to ensure Article 31 Mental Health Clinic are reimbursed at the newly effective rates as listed above and are required to conduct retrospective reconciliation to adjust payment for claims as necessary within 90 days of receipt of this notification.
Please note that this document is only being transmitted electronically. No hard copy will be forthcoming.
If you have any questions regarding these changes, please contact OMH Managed Care at 518-402-2822 or BHO@omh.ny.gov
Thank you,
Office of Mental Health
Division of Managed Care
44 Holland Avenue, Albany, New York 12229
[1] https://www.health.ny.gov/health_care/medicaid/redesign/hcbs/enhanced_funding/
[2] Please see the rate sheets in section titled “Mental Health Outpatient Treatment and Rehabilitative Services”.