Enrollment of Medicaid Managed Care Behavioral Health Providers in Medicaid
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1 Enrollment of Medicaid Managed Care Behavioral Health Providers in Medicaid Section 5005(b)(2) 21st Century Cures Act November 8, 2017
2 November 8, 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 2 2
3 November 8, What is this about? The 21st Century Cures Act (Act) requires all Medicaid Managed Care (MMC) and Children s Health Insurance Program providers to enroll with state Medicaid programs by January 1, 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. 3
4 November 8, 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.
5 November 8, Examples of Medicaid enrollment requirements for BH provider types: PROVIDER TYPE Licensed Mental Health Counselor Licensed Marriage Family Therapist CSW (Clinical Social Worker) Applied Behavioral Analyst Adult Home And Community Based Services OMH Children's Home and Community Based Services OMH LMSW (Licensed Master Social Worker) OMH Licensed ACT Provider OMH Licensed PROS Provider OMH Licensed Outpatient Provider ENROLLMENT REQUIREMENT Not required to enroll Not required to enroll Required to enroll (required to enroll in Medicare prior to Medicaid) Not required to enroll Not required to enroll Required to enroll Not required to enroll Required to Enroll Required to Enroll Required to Enroll A comprehensive list of provider types who can currently enroll in Medicaid (NYS Enrollable Providers) is located at:
6 November 8, 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
7 November 8, 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
8 November 8, COS that must enroll (cont d) 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
9 November 8, COS that must enroll (cont d) 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
10 November 8, 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 Business, Group Practice and Institutional providers can verify their enrollment by calling emedny Call Center at (800)
11 November 8, 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.
12 November 8, 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 nonbiller 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
13 November 8, Frequently Asked Questions FAQs are available, along with other resources, at: FAQs will be expanded on an ongoing basis
14 Contacts For assistance with completing enrollment forms and status of enrollment transactions, contact the emedny Call Center at For general provider enrollment questions, the Bureau of Provider Enrollment at For OMH specific questions, the mailbox.
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