September 30, 2024
Looks like the OASAS Website now includes some information about the new Commercial Rate mandate. I just called the Office to clarify whether or not there is more coming specifically from OASAS on this topic. Stand by.L.
Commercial Billing (Part AA of Chapter 57) Guidance
This section is for commercial health insurers and OASAS-certified substance use disorder providers. It provides guidance on complying with laws related to commercial reimbursement and billing for OASAS-certified ambulatory programs.
Part AA of Chapter 57 of the Laws of 2024 updated the Insurance Law to require insurance companies to pay certain in-network facilities that offer outpatient mental health and substance use disorder treatment. These payments must be at negotiated rates that are at least as high as what would be paid under the Medicaid program.
Chapter 57 requires that insurers must reimburse covered outpatient treatment provided by OASAS-certified providers.
Provider Types
- Outpatient Clinic Providers* – Both hospital and freestanding, reimbursed under Ambulatory Patient Groups (“APGs”).
- Outpatient Rehabilitation Providers* (aka OP Addiction Day Rehab) – Both hospital and freestanding, reimbursed under APG.
- Opioid Treatment Program* (“OTP”), including mobile medication services delivered by a mobile medication unit and Comprehensive Outpatient Program* (“COP”) providers– both hospital and freestanding, reimbursed under APGs including the weekly bundled rate.
- Mobile Crisis Intervention Services providers.*
- Crisis Stabilization Centers licensed pursuant to Mental Hygiene Law § 36.01.
* Please note all facility types listed above with (*) may provide services in the community.
Commercial Billing Resources
The following resources can be used to support commercial insurers and substance use providers with systems configurations needed for the implementation of Part AA, effective on or after January 1, 2025.
OASAS Ambulatory Provider Level Fee Schedule
This Excel file contains provider-specific Ambulatory Provider Group base rates with associated rate codes.
Ambulatory Provider Level Fee Schedule (Excel)
APG Outpatient Rate List
This Excel document contains fee schedules for OASAS outpatient services applicable to Part AA that are priced using the Ambulatory Provider Group methodology. It includes applicable rate codes.
APG Outpatient Rate List (Excel)
Upcoming Webinars/Trainings
Check back soon for upcoming webinars/training sessions.
Office of Mental Health Website
Visit the Office of Mental Health Commercial Billing for Behavioral Health Services webpage for reimbursement rates for OMH ambulatory programs.