August 25, 2023

Below is the latest from OASAS re:  anticipated increases that have been pending for many months:

Note:  The NYS Council has been informing members of these pending rate increases for many months, and pushing for expedited approvals downtown.  OASAS funding for these increases is (in large part) the result of NYS Council advocacy that resulted in a DOH MCO enforcement in which the state recouped overpayments that were made to some MCOs that failed to meet contractually required expenditure targets.  The state likes to refer to these funds as  ‘savings associated with the carve-in of BH services to Medicaid managed care’ and ‘reinvestment’ – we see it very differently.  These funds are the result of an enforcement of a contractual requirement that the state let slip for many years.  The first installment of funds going back to the state was $222M over a two year period.    #NYSCouncilAdvocacyWorks!

Recoupment of the overpayments resulted in OASAS and OMH realizing additional funds that they have used / are using to increase rates and incentivize certain outcomes.   We are grateful that these decisions will ultimately help to expand access to and continuity of care, and we thank the Governor’s Office for hearing our plea re:  the necessity of the enforcement (discussed above).  

– 5.0% trend on every OASAS Medicaid service except hospital inpatient – DOB has approved retro to 1-1-23 and OASAS is in the process of loading the rates and notifying plans and providers.  This approval includes the 40% off-site enhancement for freestanding outpatient programs.

– 40% peer service APG weight increase, and 10% average SUD medical visit E&M weight increase in APGs – DOB approved effective Jan 1, 2023.  (Providers previously notified.)  

– Part 820 Residential Rate Increases – DOB has approved effective 3-1-23. OASAS is in the process of loading the rates and notifying plans and providers.

– Complex Care Management – unit of service changes from 15 minutes to 5 minutes (4 unit maximum) – DOB approved effective 4-1-23. This effectively triples the payment.

– Still pending at DOB:  4.0% COLA effective 4-1-23, and APG parity between service types effective 1-1-24.  (I’m checking on this last notation about APG parity as I’m unsure of specifics).