OTP Parity Adjustments for Outpatient Programs

December 12, 2023

The New York State Division of Budget recently approved rate adjustments meant to bring base rates for all Outpatient Programs into more equitable alignment.  To accommodate these changes the procedure weight for H0020 and H0033 will be decreased from 0.1335 to 0.1179.  The change in base rates should balance out the procedure weight change.

The attached document was sent to the Medicaid Managed Care Plans notifying them of the changes and the expectation for reimbursement.

  • MMC Plans have up to 90 days from the notification letter to update their systems with the rate changes.
  • Plans are required to provide the additional reimbursement without further action of the providers.

Providers are encouraged to:

  • Review the attached document which explains the rate changes and gives the effective date.
  • Reach out to their plan representatives for status on system reconfiguration.
  • Keep a spreadsheet of the impacted claims for any future reimbursement issues.

If you have further questions please email PICM@oasas.ny.gov