2016 State Agency News
2016 State Agency News
December 30 – December Medicaid Update Posted
The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the December 2016 Medicaid Update. Please find the full current issue as a PDF (Portable Document Format) file available to be downloaded at:http://www.health.ny.gov/health_care/medicaid/program/update/2016/dec16_mu.pdf
December 12 – DOH Web site updated with Webinar slides/presentations
The APG website has been updated to reflect the following change:
- APG Updates/Policy Changes – 2016 Updates: “Safety Net Payments Webinar- December 1, 2016” was posted. (https://www.health.ny.gov/health_care/medicaid/rates/updates/2016/index.htm )
- Information regarding APGS can be found on the Department website at: https://www.health.ny.gov/health_care/medicaid/rates/apg/index.htm
December 8 – Children’s SPA/HCBS DRAFT Provider Manuals Now Available
In preparation for the release of the Children’s SPA/HCBS Provider Designation Application, anticipated for December 14, the revised draft SPA Provider Manual and draft HCBS Provider Manual have been posted to the DOH Children’s Managed Care Website at the below links. The State interagency team encourages providers who are considering applying for SPA or HCBS designation to review the manuals as another tool in the decision making process. More information and technical assistance will be forthcoming next week.
The updated Draft SPA manual has been posted at http://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/2016-12-06_draft_spa_prov_manual.pdf
The Draft HCBS Manual has been posted at http://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/2016-12-06_draft_hcbs_prov_manual.pdf
December 7 – CMS approved NY 1115 Waiver
CMS has approved New York’s request to extend its Medicaid Section 1115 waiver, the Medicaid Redesign Team (MRT) Demonstration, through March 31, 2021.
The 1115 waiver has been renamed from the Partnership Plan to the MRT Demonstration as a reflection of the significant MRT efforts that have improved and expanded the waiver’s purpose. This approval is the result of significant efforts by both the New York and CMS teams, and has been informed by extensive stakeholder input. Thank you to all who have contributed to this effort. The Special Terms and Conditions (STCs) will be posted shortly and an announcement will be sent to this listserv.
December 5 – Insurance Law Change Update
OASAS has shared Guidance for the Implementation of Coverage and Utilization Review Changes Pursuant to Chapters 69 and 71 of the Laws of 2016.
December 1 – 2016 Compliance Program Certification Information and Forms Posted on OMIG Website
2016 Compliance Program Certification information and forms for the December 2016 certification period are now posted on the New York State Office of the Medicaid Inspector General (OMIG) website at: www.omig.ny.gov/compliance/
NOTE: Certifying providers are reminded to complete and submit the 2016 Certification Form; 2015 Certification forms are no longer applicable and will not be accepted for the 2016 annual certification.
In addition, Webinar #36 – OMIG’s Certification Process: Mandatory Compliance Programs & Deficit Reduction Act of 2005 is available at: http://bit.ly/2gc0hNi.
Webinar #36 provides detailed information on how to complete the Mandatory Compliance Program Certification and the Deficit Reduction Act Certification. Required providers with an annual certification obligation must complete and submit the certification by December 31, 2016.
Further, in response to providers’ requests, OMIG revised the Mandatory Compliance Program Certification to allow providers to certify multiple FEINs/SSNs on one certification form, if five conditions are met. The updated directions on the form outline the five conditions that must be in place in order to certify multiple FEINs/SSNs on a single form. Providers still have the option of completing separate certification forms for each FEIN/SSN, if they prefer.
November 30 – November Medicaid Update Posted
The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the November 2016 Medicaid Update. Please find the full current issue as a PDF (Portable Document Format) file available to be downloaded at: http://www.health.ny.gov/health_care/medicaid/program/update/2016/nov16_mu.pdf
November 18 – Federal Approval of Adult BH HCBS Rates
New York State has received DOB approval for the Adult BH HCBS rates and they have been loaded into eMedNY. This includes the changes reflected below.
Please note that rate codes 7781, 7782, and 7783 are not available at this time.
Here is a link to the final Adult BH HCBS Fee Schedules for NYC and Rest of State: http://omh.ny.gov/omhweb/bho/billing-services.html
October 26 – OMIG Posts ‘Compliance Program Review Guidance’
The New York State Office of the Medicaid Inspector General (OMIG) has posted on its website Compliance Program Review Guidance, which details what OMIG looks for when assessing compliance programs required under New York State Social Services Law § 363-d and 18 NYCRR Part 521.
The extensive Guidance addresses all requirements under each of the eight elements as well as the seven prime risk areas, which include billing, payment, medical necessity and quality of care, governance, mandatory reporting, credentialing, and other risk areas. This Guidance is not intended to replace any prior guidance offered by OMIG.
October 19 – The NYS Department of Financial Services has issued new Guidance pertaining to coverage for Substance Abuse Treatment. DFS oversees the commercial insurance market here in New York while DOH regulates Medicaid and other public insurance products.
October 17 – New York State Medicaid Director, Jason Helgerson, highlighted DOH goals beyond DSRIP and beyond the goals of trying to achieve a more cost-effective health care delivery system. The White Board presentation also describes how the health care sector can collaborate with other similar systems to improve the health, well-being, and the happiness of all communities.
White Board are 5 minute presentations designed to share information with healthcare stakeholders across New York.
September 1 – OMIG Compliance Update
The New York State Office of the Medicaid Inspector General posted on its website OMIG Compliance Guidance 2016-01, which directs that the Certifying Official on certifications of Medicaid providers’ compliance programs must be the person to whom the Compliance Officer reports. This eliminates the previous direction by OMIG that only recommended that the Certifying Official be someone to whom the Compliance Officer reports. Directions on the certification form to reflect this new direction will be made when the certification form is updated starting on December 1, 2016.
September 1 – August Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health recently got a new look and main page for the Medicaid Update. It can be viewed along with the newly approved August 2016 Medicaid Update.
July 28 – New Consolidated Fiscal Reporting and Claiming Manual Released
The Consolidated Fiscal Reporting and Claiming Manual (CFR Manual) and forms for the July 1, 2015 to June 30, 2016 reporting period are now available. For a summary of notable changes and State Agency specific information, click here.
The updated CFR Manual includes changes related to Medicaid Managed Care, such as establishing a definition for “Medicaid Managed Care” and creating separate lines to distinguish between Medicaid Fee for Service and Medicaid Managed Care. Read the full announcement for these and other important changes here.
July 27 – July Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health recently got a new look and main page for the Medicaid Update. It can be viewed along with the newly approved July 2016 Medicaid Update and can better accommodate smaller devices.
July 14 – UHF Medicaid Conference: Helgerson Presentation
On Thursday, July 14, 2016, New York State Medicaid Director, Jason Helgerson, presented the keynote address at the United Hospital Fund’s (UHF) 2016 Medicaid conference. His power point presentation and a recording of his speech, titled “State of the Medicaid Program, Past, Present and Future,” can be found on the UHF website, https://www.uhfnyc.org/publications/881149. For other information about the conference visit,https://www.uhfnyc.org/events/881110.
July 5 – Health Home Community Referral Guidelines
DOH, OMH, and OASAS has released the most up-to-date guidelines for making community referrals to Health Home Care Coordination. PROS providers are encouraged to identify individuals who can benefit from Care Coordination and especially HARP enrollees and make referrals to Health Home Care Coordination.
June 29 – June 2016 Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health recently got a new look and main page for the Medicaid Update. It can be viewed along with the newly approved June 2016 Medicaid Update and can better accommodate smaller devices.
June 7 – DRAFT Revised NYS DOH Provider Contract Guidelines for MCOs and IPAs
The Department of Health has released a DRAFT of the revised New York State Department of Health Provider Contract Guidelines for MCOs and IPAs. The guidelines are being revised to modify the contract submission and review process to reflect Value Based Payments arrangements pursuant to the New York State Value Based Payment Roadmap and the Regulatory Impact Subcommittee. Any comments on the Guidelines should be submitted by June 30, 2016 to email@example.com
June 2 – OASAS DRAFT Part 822 Outpatient Site Review Instrument
The OASAS Program Review Unit is scheduled to resume unannounced recertification reviews of Part 822 outpatient programs in approximately one month. Attached is the “almost final” version of the Part 822 site review instrument for outpatient programs. This instrument was developed by an internal OASAS team and reviewed by OASAS Counsel. The instrument is based on the final version of the Part 822 regulation, which is posted on the OASAS website.
OASAS has created a YouTube Training to provide further guidance to the new Part 822 Regulations, Clinical Standards, and the impact of Medicaid Managed Care. The YouTube link is as follows: https://www.youtube.com/watch?v=8RY25f4Np7g.
To prepare for upcoming recertification reviews, please closely review the taped training, as well as the draft site review instrument. A separate site review instrument for Part 822 opioid treatment programs will be developed shortly.
June 2 – May 2016 Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health has a new look and main page for the Medicaid Update. It is being released along with the newly approved May 2016 Medicaid Update and can better accommodate smaller devices.
May 6 – OASAS Certified Recovery Peer Advocate
In an effort to encourage the implementation of Peer Services in OASAS certified outpatient clinics, OASAS has approved a Certified Recovery Peer Advocate (CRPA) Provisional certification for individuals for a limited period of time, which will be accepted for payment for peer services in reimbursable Medicaid APG and HCBS settings. It can be implemented by the approved Certification Boards as soon as June 1, 2016 and at the latest November 1, 2016. This will allow individuals who have completed the minimum educational requirements of the CRPA certification and secured a setting to complete their work experience and supervision requirements, to apply for a CRPA Provisional certification at one of the OASAS approved Certification Boards below. OASAS outpatient providers who are interested in taking advantage of this opportunity should be aware of the following resources/information:
Reimbursement Rate for Peer Services: $10.28-$13.05 per 15 minutes depending on location and clinic type – http://www.oasas.ny.gov/mancare/APGService.cfm
Peer Support Toolkit: https://www.bhwellness.org/resources/toolkits/peer
OASAS Approved Peer Certification Boards:
April 15 – OMIG 2016-17 WORK PLAN POSTED ONLINE
OMIG has released its 2016-17 Work Plan, detailing the areas of focus in the Medicaid program for State Fiscal Year April 1, 2016 to March 31, 2017.
This year’s Work Plan continues a focus on organizing work according to categories of service. Building on the 2015-16 Work Plan, OMIG continues to utilize its Business Line Teams across a number of areas, including but not limited to the Delivery System Reform Incentive Payment Program (DSRIP), Managed Long Term Care, Transportation, Home and Community Care Services, and Managed Care. Further, OMIG will continue to emphasize provider outreach and education, particularly focusing on providers having proactive compliance programs that will prevent or, when necessary, detect and address abusive practices. Through its array of compliance webinars, guidance materials, self-assessment tools, presentations, and a dedicated compliance email address and phone number, OMIG’s oversight activities and educational efforts increase provider accountability and contribute to improved quality of care.
The 2016-17 Work Plan, and plans from previous years, can be viewed at: https://www.omig.ny.gov/index.php/information/work-plan
March 28 – OASAS Criminal Background Check Process
As of March 25, 2016, OASAS will be paying for the cost of the fingerprint for all applicants as long as the correct ORI number is used. When you schedule a fingerprint appointment with MorphoTrust (identogo.com), you will no longer see a payment screen, the billing account will automatically be charged. You will no longer need to enter the billing account number. The account will continue to be audited. If anyone misuses the billing account, the provider will be required to reimburse OASAS for any expenses associated with the misuse and will also be subject to additional penalties.
Please continue to follow the steps at identogo.com to schedule an appointment.
The OASAS ORI number is NY922287Z. (OMH and OPWDD have different ORI numbers Contact the Justice Center if you have to print an individual for one of those agencies.) You must also use the correct agency provider number when you are scheduling prospective hires for fingerprinting. Do not use the Credentialing provider number.
Prospective hires should only be fingerprinted for OASAS once you have offered the individual employment. Criminal background checks are not a screening tool. Once you have made the offer, check the Staff Exclusion List (SEL). When you receive SEL clearance, please schedule the fingerprint appointment.
Please be advised that on Thursday, March 31, 2016, NYS Division of Criminal Justice Services will be joining the National Fingerprint File compact with the FBI. As this change is implemented we expect processing delays. Please continue to check the CBC system for current statuses, but please feel free to contact our office at firstname.lastname@example.org with any questions.
March 23 – March 2016 Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the March 2016 Medicaid Update.
January 29 – January 2016 Medicaid Update
The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the January 2016 Medicaid Update.
January 15 – Billing and Administering BH HCBS Assessments for HARP Enrollees
The State has released several documents related to billing and administering the Behavioral Health Home and Community Based Services (BH HCBS) assessments and the BH HCBS workflow for HARP enrollees:
- Billing Guidance for the Administration of the NYS Eligibility Assessment for Behavioral Health Home and Community Based Services (BH HCBS) and the NYS Community Mental Health Assessment
- Community Mental Health Assessment Billing Procedures presentation from January 8, 2016 webinar
- Plan of Care (POC) Workflow Questions and Answers collected from the webinar held on 11/13/15 on the updated POC Workflow. The POC Workflow can be found here.
Please note that separate guidance regarding billing for the BH HCBS assessments for non-HH members and for individuals receiving ACT services will be forthcoming.
January 12 – OASAS Use of LOCADTR 3.0
As we have made the transition to Medicaid Managed Care in NYC (and continue preparations for the rest of the state), we are continually asked by OASAS providers whether they have to use the OASAS LOCATDR 3.0. My answer is why would you not use it? Here are my reasons for making that statement:
- As of July 1,2015, all Medicaid managed care plans (MMC) must use LOCATDR 3.0 and we would expect our providers to use it as well. Remember, one of the reasons we mandated all MMC plans use our tool was that we could hopefully then have everyone using the same tool and that would eliminate some of the provider/plan disputes;
- If you are a provider outside of NYC, why wouldn’t you start using the LOCATDR 3.0 now so that you are fully prepared for the July transition?
- It is our hope that eventually we will convince or mandate that ALL insurers (Medicaid and private) use LOCATDR 3.0.