May 14, 2024
I have been relentlessly pestering O agency representatives in hopes of getting confirmation of the list of OASAS and OMH Outpatient Programs and Services that are impacted by Part AA – the new commercial rate mandate that was enacted as part of the SFY25 state budget and that becomes effective Jan. 1. 2025 and upon contracting, re-contracting, amending contracts, etc. between in-network providers and insurers.
Below is an initial list of programs/services impacted by Part AA. The information is broken out by OMH/OASAS with a few clarifying notes:
OMH services that are subject to the new law:
o Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) – Reimbursed using APGs
o Assertive Community Treatment (ACT)
o Continued Day Treatment (CDT)
o Comprehensive Psychiatric Emergency Program (CPEP) – excluding Extended Observation Beds (EOB)
o Coordinated Specialty Care (Specialty services for individuals experiencing First Episode Psychosis) – pending the establishment of rates effective prior to 10/1/24 as required by the statute.
o Crisis : Mobile and Telephonic
o Crisis: Stabilization
o Day Treatment Services for Children
o Partial Hospitalization
o Personalized Recovery Oriented Services (PROS)
o Children and Family Treatment and Support Services (CFTSS) – includes Other Licensed Practitioner (OLP), Community Psychiatric Support and Treatment (CPST), Psychosocial Rehabilitation (PSR), Family Peer Support Services (FPSS), and Youth Peer Support and Training (YPS)
·OASAS services that are subject to the new law:
o Outpatient Clinic (aka OP Addiction Rehab) – both hospital and freestanding, reimbursed only under APGs
o Outpatient Rehabilitation (aka OP Addiction Day Rehab) – both hospital and freestanding, reimbursed only under APGs
o Opioid Treatment Programs – both hospital and freestanding, reimbursed under both APGs and OTP “weekly bundles” (at the provider’s option)
o Intensive Outpatient
OMH/OASAS:
· Certified Community Behavioral Health Clinics (CCBHC) – Licensed as either OMH Part 599 or OASAS Part 822 Outpatient Addiction Services programs – not paid using APGs/CCBHC Demos are reimbursed under a provider-specific PPS rate. Note a NYS Demo expansion of this program will include new providers with initial rates effective 7/1/24. These expansion providers will only become subject to the requirements of Part AA under the effective dates proscribed by the statute (January 1, 2026).
Any questions regarding the floor rates applicable to OHM licensed facilities should be directed to: commercial-billing@omh.ny.gov
Any questions regarding the floor rates applicable to the OASAS licensed facilities should be directed to Ben Clark at Benjamin.Clark@oasas.ny.gov
The O agencies will be enhancing the Commercial Insurance footprint on their agency websites to make final fee schedules clear – more to follow.