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November 8, 2017 Enrollment of Medicaid Managed Care Behavioral Health Providers in Medicaid Section 5005(b)(2) 21st Century Cures Act

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  • November 8, 2017

    Enrollment of Medicaid Managed CareBehavioral Health Providers inMedicaid

    Section 5005(b)(2)21st Century Cures Act

  • 2

    November 8, 2017 2

    2

    Agenda What is this about?

    Outreach Letter Sent By Medicaid Managed Care Plans

    Feedback from OMH Providers

    Categories of Service that must Enroll

    Enforcement of Enrollment Requirement/Terminations

    Updated FAQs

  • 3

    November 8, 2017 3

    What is this about? The 21st Century Cures Act (Act) requires all Medicaid Managed Care (MMC)

    and Childrens Health Insurance Program providers to enroll with state Medicaid programs by January 1, 2018.

    The Act requires that enrollment of providers includes identifying information: name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.

  • November 8, 2017 4

    MCO Provider Enrollment Outreach Letter

    Requirement: Only send notice to providers not enrolled and able to enroll.

    Feedback from provider community: Some MCOs sent Outreach Letter to all network providers, including:

    providers who are already Medicaid enrolled; and providers who cannot enroll in Medicaid.

  • November 8, 2017 5

    Examples of Medicaid enrollment requirements for BH provider types:

    A comprehensive list of provider types who can currently enroll in Medicaid (NYS Enrollable Providers) is located at: https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx

    PROVIDER TYPE ENROLLMENT REQUIREMENT

    Licensed Mental Health Counselor Not required to enroll

    Licensed Marriage Family Therapist Not required to enroll

    CSW (Clinical Social Worker) Required to enroll (required to enroll in Medicare prior to Medicaid)

    Applied Behavioral Analyst Not required to enroll

    Adult Home And Community Based Services OMH Not required to enroll

    Children's Home and Community Based Services OMH Required to enroll

    LMSW (Licensed Master Social Worker) Not required to enroll

    OMH Licensed ACT Provider Required to Enroll

    OMH Licensed PROS Provider Required to Enroll

    OMH Licensed Outpatient Provider Required to Enroll

    https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspxSheet1

    PROVIDER TYPEENROLLMENT REQUIREMENT

    Licensed Mental Health CounselorNot required to enroll

    Licensed Marriage Family TherapistNot required to enroll

    CSW (Clinical Social Worker) Required to enroll (required to enroll in Medicare prior to Medicaid)

    Applied Behavioral AnalystNot required to enroll

    Adult Home And Community Based Services OMHNot required to enroll

    Children's Home and Community Based Services OMHRequired to enroll

    LMSW (Licensed Master Social Worker)Not required to enroll

    OMH Licensed ACT ProviderRequired to Enroll

    OMH Licensed PROS ProviderRequired to Enroll

    OMH Licensed Outpatient Provider Required to Enroll

  • November 8, 2017 6

    Categories of Service (COS) that must enroll Adult Day Health Care Provider

    (ADHC) Ambulatory Surgery Center (ASC) Assisted Living Program (ALP) Audiologist (1)

    Bridges to Health Waiver Provider (B2H)

    Care at Home Waiver Provider (CAH) Case Management Provider (CMCM)

    Certified Asthma Educator (CAE) (1)

    Certified Diabetes Educator (CDE) (1)

    Chemical Dependency Program (CDP)

    Child (Foster) Care Agency (CCA) Children's Health and Behavioral

    Transformation Chiropractor (1)

    Clinic, Diagnostic & Treatment Center (D&TC)

    (1) Eligible to enroll as an OPRA or FFS provider

  • November 8, 2017 7

    Categories of Service (COS) that must enroll: Durable Medical equipment supplier Early Intervention Program provider Eye Prosthesis/ Occularist Freestanding Clinic (D&TC) Health Homes Hearing Aid Supplier Hemodialysis Center (freestanding) Home Health Agency

    Hospice Provider Hospital (Inpatient and Outpatient) Intermediate Care Facilities for

    Individuals with Intellectual Disabilities (OPWDD (ICF/ IDD)

    Laboratory (LAB) Laboratory Director (LBD) Long Term Home Health Care

    Program (LTHHCP) Managed Care Plan (MCP)

    (1) Eligible to enroll as an OPRA or FFS provider

  • November 8, 2017 8

    COS that must enroll (contd)

    Midwife/Nurse Midwife (1)

    Nurse (LPN/RN) (1)

    Nurse Practitioner (1)

    Nurse Registry Nursing Home - RHCF Nursing Home Transition/Diversion

    (NHTD) OASAS Part 820 Residential

    Treatment Program

    OMH Community Residence OMH Licensed ACT Provider OMH Licensed Outpatient Provider OMH Licensed PROS Provider OMH Lic. Residential Treatment

    Facility (RTF) Optical Establishment Optician/Opthalmic Dispenser

    (OPD) (1) Optometrist (OPT) (1)

    (1) Eligible to enroll as an OPRA or FFS provider

  • November 8, 2017 9

    COS that must enroll (contd)

    OPWDD Community Residence OPWDD Waiver Provider Personal Care Agency (PCA) Personal Emergency Response

    Provider (PERS) Pharmacy Physician (1)

    Practitioner Groups Physician Assistant (Registered) (1)

    Podiatrist (1)

    Portable X-Ray Provider School Supportive Health Service

    Provider (SSHSP) Service Bureau Supervising Pharmacist Therapist (PT, OT, Speech) (1)

    Transportation Provider Traumatic Brain Injury (TBI)

    Provider (1) Eligible to enroll as an OPRA or FFS provider

  • November 8, 2017 10

    How to identify if a provider is already enrolled as a Medicaid FFS provider

    Practitioners can verify if they are enrolled by using the enrolled practitioners search function found on https://www.emedny.org/info/opra.aspx

    Business, Group Practice and Institutional providers can verify their enrollment by calling eMedNY Call Center at (800) 343-9000

    https://www.emedny.org/info/opra.aspx

  • November 8, 2017 11

    Enforcement of Enrollment Requirement

    DOH is in the process of obtaining the enforcement date from CMS for the Medicaid enrollment requirement.

    MCOs are being directed to not begin terminating network providers until DOH provides guidance on the enforcement date.

  • November 8, 2017 12

    What next? Practitioners who only want to service patients through a MMC plan can enroll

    as a non-billing, Ordering/Prescribing/Referring/Attending (OPRA) provider.

    Business, Group Practice and Institutional providers may also enroll as a non-biller by checking the appropriate box at the top of their application.

    Enrollment in Medicaid FFS does not require them to accept Medicaid FFS patients.

    If they were a Medicaid FFS provider at one time, they may be able to keep their original provider identification number (PID), also known as MMIS ID, by checking the appropriate reinstatement box on the application

  • November 8, 2017 13

    Frequently Asked Questions

    FAQs are available, along with other resources, at: https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx

    FAQs will be expanded on an ongoing basis

    https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx

  • ContactsFor assistance with completing enrollment forms and status of enrollment transactions, contact the eMedNY Call Center at 1-800-343-9000

    For general provider enrollment questions, email the Bureau of Provider Enrollment at [email protected]

    For OMH specific questions, email the [email protected] mailbox.

    mailto:[email protected]:[email protected]

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