For many years, behavioral health services have been "carved out" of the Medicaid managed care benefit package. This means that most mental health services are accessed on a fee for service basis outside of the member's managed care plan. Posted here are the Medicaid provider billing codes for behavioral health services that -- up til 2016 when these changes go into effect --were carved-out of the Medicaid managed care benefit package for individuals who receive SSI.
BIG CHANGES COMING IN 2016
One of the many "Medicaid Redesign Team" changes in Medicaid service delivery is Behavioral Health Transition to Managed Care. The NYS Behavioral Health (BH) Transition Team for Medicaid, comprised of leads from OASAS, OMH, and DOH, is updating the target dates for implementing the transition of BH services. Click on this link for information about this transition, which involves new concepts in managed care -- Behavioral Health Organizations and Health and Recovery Plans (HARPs).
See this MRT TRANSITION TO BEHAVIORAL HEALTH MANAGED CARE with Revised Timeline for target dates of implementation starting in NYC in 2015 - with additional information about HARPs.
July 2015 - First Phase of HARP Enrollment Letters Distributed (see below for an explanation of initial enrollment process)
60,000 NY Medicaid Choice enrollment letters were distributed in three phases for enrollment in October, November and December 2015 (20,000 for each month). These are sent only to those identified as HARP-eligible because of their past usage of behavioral health services.
Most people are receiving an "announcement" notice sent to people whose managed care plan is directly providing behavioral health services or is affiliated with its own HARP. They will be passively enrolled into that plan unless they opt out. Here is the second notice sent of passive enrollment. Some people are receiving a "voluntary" notice telling them to choose their own HARP because their plan does not offer one. .
October 1, 2015 - Mainstream Plans and HARPs implement non-HCBS behavioral health services for enrolled members
October 2015-January 2016 - HARP enrollment phases in - see more below about passive enrollment
January 1, 2016 - HCBS begin for HARP population
June 30, 2015 - RFQ distributed (with expedited application for NYC designated Plans)
October 2015 - Conditional designation of Plans
October 2015-March 2016 - Plan Readiness Review Process
April 1, 2016 - First Phase of HARP Enrollment Letters Distributed
July 1, 2016 - Mainstream Plan Behavioral Health Management and Phased HARP Enrollment Begins
January 1, 2017 - NYC and Long Island Children´s Transition to Managed Care
July 1, 2017 - Rest of State Children´s Transition to Managed Care
Individuals initially identified by NYS as HARP eligible, based on past usage of behavioral health services, who are already enrolled in an MCO with a HARP, will be passively enrolled in that Plan's HARP.
See "announcement notice" sent to people whose managed care plan is sponsoring its own behavioral health organization or HARP, telling them they will be passively enrolled unless they choose another HARP.
See second notice from NY Medicaid Choice following up on the announcement notice, telling member they will be passively enrolled.
Click here top view sample HARP Notices.
Individuals identified for passive enrollment will be contacted by the NYS Enrollment Broker. These are people who are in Medicaid managed care plans that have an affiliated HARP or which have been approved to manage the behavioral health services inside the plan.
They will be given 30 days to opt out or choose to enroll in another HARP.
Once enrolled in a HARP, members will be given 90 days to choose another HARP or return to Mainstream before they are locked into the HARP for 9 additional months (after which they are free to change Plans at any time).
Individuals initially identified as HARP eligible who are already enrolled in an MCO without a HARP will not be passively enrolled. They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker to help them decide which Plan is right for them.
HARP eligible individuals in an HIV SNP will be able to receive HCBS services through the HIV SNP. They will also be given the opportunity to enroll in another HARP. They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker to help them decide which Plan is right for them. They can switch back and forth between HARP and HIV SNP.
Call OMH customer relations line at 1-800-597-8481
http://www.mctac.org/ - Managed Care Training Assistance Center for providers and managed care plans - has public information as well
FAQs - DOH - October 2015
FAQs for Consumers - DOH - Sept. 2015
NYS Policy Paper on Behavioral Health Transition (Oct. 1, 2015)
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