Hi everyone – The following comes from Gary Weiskopf at OMH. As Gary says in his email – “the transition is upon us”.
I am sending this to the entire state even though these only apply to NYC. It will give the Rest of State (ROS) providers a glimpse into the future.
There are three attachments that can be found next to their descriptions below.
This package of information does not apply to residential services unless you are in a FIDA PILOT area and have FIDA clients – very unlikely as the enrollment in FIDA has been extremely low and most FIDA clients would not be eligible for residential services. However, everyone should start to familiarize themselves with these documents as it will be everyone’s issue soon enough.
From OMH: Dear Behavioral Health Provider –
Attached are three files for your information:
- Final Draft Behavioral Health Billing Guidance – The first section of the document called “New York State HARP Mainstream BH Billing and Coding Manual” provides billing mechanics for all the Medicaid fee-for-service “government rate” services (including OMH licensed and OASAS certified services). This should be reviewed in conjunction with attachments 2 and 3. The second section of the manual gives detailed information on OASAS services. There are numerous links in this document, provided for your convenience. 3-18-15 NYS HARP Mainstream BH Billing Manual – Draft 2015
- Coding Taxonomy – This Excel file provides the required coding construct for billing the government rates services. All OMH licensed and OASAS certified providers must submit claims to Managed Care Plans using the coding contained herein. Coding Taxonomy FINAL DRAFT 3-17-15
- HCBS fee schedule – This shows the required coding combinations to bill the Managed Care Plan for the provision of these services. The rate codes that you will use to bill Plans, in conjunction with procedure and modifier codes, will be provided in the near future and are subject to CMS and NYS DOB approval. Only HCBS designated providers are eligible to be reimbursed for these services. HARP HCBS Fee Schedule – FINAL DRAFT 3-16-15 for distribution
Please keep in mind the transition is upon us. Announcement letters for the New York City adult behavioral health managed care transition will be mailed mid-April through mid-June.
Please call (518) 474-6911 or e-mail [email protected] with questions.
ACL NOTE: ON THE HCBS SERVICE RATES:
We are compiling a list of questions to send to OMH. We will send FAQs as soon as we get answers to our questions. Meanwhile, send your questions along to us and we will forward them.
Some of our initial questions on the waiver service rates include the following:
- Unit Limits are clear for respite categories but not for the rest – are these weekly, daily, monthly limits?
- We understand that there is a combined limit. How does this work?
- Will OMH send guidance regarding approved sites in compliance with the CMS Final Settings rule?
- Community Psychiatric Support and Treatment can only be done “off-site.” Is the office/place that houses the staff the “site”, even if that is a CR or CR-SRO or SP-SRO?
- If they use CR beds as non-dedicated Crisis Respite:
- Are the regulations waived?
- Can a person be discharged to the CR that is hosting them as a crisis respite client?
- Would this be a way for discharge coordinators and SPOAs to get around wait lists for the most challenging clients?
- All Crisis services set a limit at 7 days. Who is responsible for discharge planning? What if the person has nowhere to go or is not ready to go? If the person has nowhere to go does the provider continue to get paid?
- The Respite rate of $150 in a CR or SP-SROs is too low. Subtract 15% for admin and the rate is $127.50. If they need a dedicated person for even 12 hours a day that is only $10.65 an hour including benefits ($7.45 an hour with 30% fringe of $3.20.) If they need more hours the hourly rate goes down from there.
- Can they use TAP apartments or unlicensed residential/housing programs (SP-SRO, SH) for non-dedicated crisis respite?
- Intensive Crisis Respite:
- Is this dedicated or non-dedicated or both?
- Given the eligibility criteria, it is not a stretch to imagine that a person may need 24/7 close supervision – this rate is inadequate. After subtracting 15% for admin it is $276.25 a day, which is $8.06 an hour with $3.45 for fringe (at 30%) over 24 hours. Although a person may need less than 24 hour supervision, even at 12 hours a day it is $16.12 an hour with $6.90 (30%) in benefits. The professional staffing requirements and the rate do not match unless you assume that a provider will have multiple people in intensive crisis at the same time to increase revenue. That may not be the case.
- In the column titled “Final Fee”, what is the 15% for travel? Is that a portion of the fee for each category or an additional fee and why would the HARP get transportation money?
ON MC in GENERAL:
- MC is starting in NYC only but FIDA PILOTS go beyond NYC. How do ROS providers deal with FIDA clients should they come across one outside of NYC? The ROS providers are not yet contracting as far as I know.