November 22, 2023
Yesterday, OMH advised me that the 90 days plans have to get ready to pay a new rate to providers (back to the effective date) now begins on the date DOB approves the rate change. (This is a departure from past practice where the 90 day clock started when the transmittal to the plans went out the door.)
The NYS Council shared the information (below) with our members last week; however, OMH just made it public. In this instance, plans have 90 days from the date of DOB approval (November 17) of the rate change to begin paying the new rate going back to the effective date of the increase (July 1, 2023).
This policy change also impacts the recent notice to plans re: the ’23-’24 4% COLA rate increase (effective April 1 and approved by DOB 8/24/23), and the Minimum Wage increase (effective Jan. 1 2023 and approved by DOB on November 17) that we shared with you recently. Plans have 90 days from each of these DOB approval dates to begin paying the increases back to their effective dates.
Confused? Feel free to call me at your convenience at 518 461-8200.
Have a good afternoon!
Lauri
From: omh.sm.co.bho <bho@omh.ny.gov>
Sent: Wednesday, November 22, 2023 11:51 AM
To: omh.sm.co.bho <bho@omh.ny.gov>
Subject: Rate Approval: July 1, 2023 Rate Increase and New APG Rate Codes for School-Based Mental Health Services in MHOTRS Programs-Division of Budget Approval (DOB)
MEMORANDUM
| To: | Mainstream Medicaid Managed Care Plans, Health and Recovery Plans (HARPs), HIV Special Needs Plans (HIV SNPs), and Medicaid Advantage Plus (MAP) Plans |
| From: | New York State (NYS) Office of Mental Health (OMH) |
| Date: | November 22, 2023 |
| Subject: | Rate Approval: July 1, 2023 Rate Increase and New APG Rate Codes for School-Based Mental Health Services in MHOTRS Programs-Division of Budget Approval (DOB) |
Dear Health Plan Administrators,
On September 8, 2023, OMH notified Mainstream Medicaid Managed Care Plans, HARPs, HIV SNPs, and MAP Plans (collectively referred to as “MMCPs” herein) of a 25 percent increase to Ambulatory Patient Group (APG) Peer Group Base Rates for School-Based Mental Health (SBMH) Services in MHOTRS Programs which became effective July 1, 2023. To receive the enhancement, services must be billed using new rate codes 1030 (Non-Hospital) and 1033 (Hospital). This memorandum is being sent to alert MMCPs that the DOB approved the rate increase for SBMH in MHOTRS Programs on November 17, 2023.
Per Chapter 57 of the Laws of 2022, MMCPs are required to pay claims based on the effective date of the rate changes. As a result, MMCPs must complete necessary system edits to ensure payable claims for applicable OMH programs and dates of service are reimbursed at the rate increase described in the September 8, 2023 memorandum. Additionally, MMCPs are required to conduct retrospective reconciliation to adjust payments for clean claims as necessary. MMCPs must complete these activities as soon as possible but no later than 90 days from the date of DOB approval (November 17, 2023).
Please refer to Mandated Rate Update – July 1 2023 Rate Increase and New APG Rate Codes For School-Based Mental Health Services in MHOTRS Programs (ny.gov) for the original notification distributed to MMCPs. The OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Rate Codes Page, CPT Procedure Weight and Rate Schedule, and CPT Revenue Calculator have been updated to reflect the new SMBH MHTORS rate codes and rate enhancement.
If you have any questions regarding these rate changes, please contact OMH Managed Care at 518-402-2822 or BHO@omh.ny.gov.
Office of Mental Health
Division of Managed Care
44 Holland Avenue, Albany, New York 12229
Are you in crisis, experiencing emotional distress, or worried about someone you know? Call or text 988 or chat at
988lifeline.org
24 hours a day, 7 days a week.