The following comes from OMH: “Effective October 1, 2015 in New York City, and July 1, 2016 in the rest of the state, an array of mental health programs and services (see below) will become covered benefits for all Medicaid Managed Care enrollees age 21 and over. To assist our licensed and funded agencies in contracting with Managed Care Plans, OMH is providing you with the attached document. This document outlines some of the specific legal requirements and accompanying guidance that the State has provided the Managed Care Plans regarding the process of entering into agreements with providers of behavioral health services.
We hope this document is helpful to you in your efforts to contract with plans that will be serving your area. This document is not intended to substitute any independent legal advice you may wish to obtain to aid you in the contracting process. Should you have any questions please contact myself or Amy Button amy.button@omh.ny.gov.”
Below, NYAPRS has excerpted the opening portion of the attached guide.
Transitioning Adult Behavioral Health Services Into Medicaid Managed Care:
Mental Health Contractual Provisions as of September 10, 2015
Expansion of the Medicaid Managed Care Benefit Package
Effective October 1, 2015 in New York City, and July 1, 2016 in the rest of the state, the following mental health programs and services will become covered benefits for ALL Medicaid Managed Care enrollees age 21 and over. Prior to the expansion of the benefit package, the mental health services covered by Medicaid Managed Care were inpatient psychiatric services in Article 28 facilities and Part 599 clinics services for non-SSI recipients.
Covered services will now include:
o Inpatient psychiatric services in Article 28 facilities
o Part 599 clinics services
o Behavioral health services in Part 598 integrated clinics
o Personalized Recovery Oriented Services (PROS) programs operated under Part 512
o Continuing Day Treatment (CDT) programs operated under Part 587
o Intensive Psychiatric Rehabilitation Treatment (IPRT) programs operated under Part 587
o Assertive Community Treatment (ACT) programs operated under Part 508
o Partial Hospitalization (PH) programs operated under Part 587
o Inpatient Psychiatric Hospitalization Services operated under Parts 580 or 582
o Comprehensive Psychiatric Emergency Programs (CPEPs) operated under Part 590
o Crisis Intervention
o Behavioral Health Home and Community Based Services (BHHCBS): available to eligible Health and Recovery Plan (HARP) and HARP-eligible HIV Special Needs Plan (SNP) enrollees only
With the upcoming transition, New York State (NYS) has provided Medicaid Managed Care plans with specific legal requirements and accompanying guidance regarding the process of entering into agreements with providers of these services.
Contractual Provisions
• New York State (NYS) is incorporating several key provisions into the Medicaid Managed Care Model contract that address: o Ensuring Medicaid Managed Care plans establish adequate behavioral health provider networks;
o Promoting financial stability through payment and claiming requirements; and
o Supporting access to and removing barriers to mental health treatment and recovery services.
• The Medicaid Managed Care Model Contract is being amended to reflect the expansion of covered benefits and to include the additional behavioral health services. The Medicaid provisions of provider agreements with the Medicaid Managed Care plans may need to be written or amended to reflect these requirements.
• The Medicaid Managed Care Model Contract provisions are applicable to only Medicaid Managed Care, HARP, and HIV SNP lines of business. Note that the proposed contract amendment is subject to review and approval by the Centers for Medicare and Medicaid Services (CMS). Because a number of clinics treat individuals with co-occurring disorders, provisions related to Substance Use Disorder medication access are highlighted in Attachment A as well.
• OMH providers are encouraged to review current and proposed amendments to provider agreements for consistency with the proposed Medicaid Managed Care Model Contract provisions outlined in Attachment A.
• Providers are strongly encouraged to finalize contracting with plans to ensure inclusion in Medicaid Managed Care provider networks prior to the effective date of the behavioral health benefit expansion.