Managed Care Updates – week 5

In this week’s update we highlight a few items of interest to the field. There is a guidance document included in this week’s update, and some important items below.

• Along with the startup of the Behavioral Health Managed Care implementation in NYC, DOH has been making adjustments to how Medicaid will handle billing for long-acting injectable medications.  Included here is a guidance memo from DOH that addresses billing for these medications.

• We have completed the first month of services and as such the first round of claims for PROS and ACT will be submitted shortly. A lot effort has gone in to testing and adjusting the claims processes for these services. We remind agencies that as you begin submitting claims you are encouraged to work with the Plans to resolve any issues that may arise. Should you have any problems that are not resolved at that level please contact us at [email protected] using the Managed Care Question Form.

• In preparation for the start of HCBS in January 2016, MCTAC has begun providing in-depth training on these services for HCBS providers and Health Home Care Managers.  The trainings offer detailed explanation of HCBS functions and components.  The trainings also focus on business aspects, including staff qualification and billing for each service. Individuals can register at www.mctac.org.

• We remind providers that the county listed on the enrollment record is the district of fiscal responsibility.  This is the key indicator as to whether someone is part of the NYC behavioral health carve-in to Medicaid managed care.  Verifying county in eMedNY is the best way to determine whether or not to bill a Plan.

Joseph Swinford
Director, Bureau of Stakeholder Engagement,
Office of Managed Care