May 24, 2024
Dear Provider,
Per the Enacted 2023-24 State Budget, the Ambulatory Patient Group (APG) Peer Group Base Rates for Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) provided at school-based mental health (SBMH) locations were increased by 25 percent, effective retroactively to July 1, 2023.
New rate codes have been established, 1030 (non-Hospital) and 1033 (Hospital-based) and were loaded in eMedNY only to SBMH locations. Services eligible for the enhanced SBMH rate must be rendered and/or facilitated through the school-based program. For the enhanced rate to be applied to SBMH claims already submitted and paid by both Medicaid fee-for-service (FFS) and managed care for dates of service July 1, 2023, and later, claim adjustments using the new rate codes and zip +4 of the school-based satellite location will be necessary. Please note: Providers are not required to submit claim adjustments; however, previously paid claims must be adjusted to the appropriate SBMH rate code (i.e., 1030/1033) from the previously submitted rate code (e.g., 1504/1516) to receive the higher SBMH rate.
When resubmitting FFS claims older than 90 days, Delay Reason Code 3: Administrative Delay must be used. eMedNY has been set to temporarily bypass the edit that would normally pend these claims for review, instead allowing claims to pay without further action by the provider. This bypass will be in effect through July 31st, 2024. No further extensions will be granted. If you have any questions, please contact OMH at medicaidffsbillinghelp@omh.nv.gov.