Frequently Asked Questions

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How often should clinical supervision be available? Does it need to be documented?

In lieu of caseload and staffing ratios, clinical supervision must be available to all staff providing direct services. Although there is no set frequency for supervision, ensuring regular availability and check-in with a clinical supervisor supports quality care, staff morale and retention, and overall professional development. It is recommended that direct service staff receive a minimum of one hour of clinical supervision for every 40 hours of service provision. Supervision does not need to be documented. Clinical supervision may be provided in groups as long as individual
consultation is also available to staff as needed.

Source: OMH & OASAS CORE FAQ Dec 2021

Can a person be in both an adult and children's health home with two care managers?

No.

Source: Children's System Transformation, Elmira, 4.13.16

Is there a process/plan to educate the Local Departments of Social Services (LDSS) on the new and aligned children's services?

Yes, there will be outreach and education provided to inform the LDSS including an Administrative Directive.

Source: Children's Aligned HCBS June 2018

Historically, staff of OMH-licensed programs do not have to register individually to bill within a program. Has the requirement changed due to the 21st Century Cures Act?

Yes. Certain individual practitioners will now need to enroll as fee-for-service Medicaid providers to remain in Medicaid Managed Care Networks. If the agency is an enrollable type, it must enroll. As indicated on eMedNY Provider Index, OMH provider types that need to enroll include but are not limited to:

OMH Community Residence OMH Licensed ACT Provider

OMH Licensed Outpatient Provider OMH Licensed PROS Provider

OMH Licensed Residential Treatment Facility.

Enrolling and Billing are separate activities and processes. Not everyone who enrolls bills for services. Reiterating, if you are an enrollable type, you must enroll in Medicaid fee for service.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What type of licensed organizations/programs are required to enroll as Medicaid providers?

Enrollable types include (partial list):

  • OMH Community Residence 
  • OMH Licensed ACT Provider
  • OMH Licensed Outpatient Provider 
  • OMH Licensed PROS Provider
  • OMH Licensed Residential Treatment Facility 
  • Chemical Dependency Program (CDP)
  • OASAS Part 820 Residential Treatment Program
  • Bridges to Health Waiver Providers
  • Children's System Transformation Providers:
    • Children and Family Treatment and Support Services
    • Children's Home and Community Based Services

 

If the agency is an enrollable type, it must enroll. See eMedNY Provider Index for more information.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What licensed professionals providing care at enrolled organizations are required to enroll as Medicaid providers?

Licensed professionals that are enrollable types are required to enroll. This may include but is not limited to

  • LPNs and RNs
    • They can enroll as OPRA non-billing if in a facility. They will be listed as an Attending provider on the claim. 
    • If the nurse is a billing provider on a private duty nursing case, the nurse must enroll as a fee-for-service billable provider.
  • Physicians 
  • Nurse Practitioners 
  • Physician Assistants
  • Clinical psychologists
  • Licensed Clinical Social Workers

Licensed Master Social Workers and Licensed Mental Health Counselors are not enrollable provider types. 

See eMedNY Provider Index

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

Where are the forms for Medicaid Provider Enrollment?

You can find the forms on the website. Provider Maintenance Forms can be found in the Provider maintenance form section. See the eMedNY Provider Index.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

How will Managed Care Organizations (MCOs) address rostered providers at facilities that need to enroll but have not?

MCOs will receive updated monthly lists from the DOH Office of Health Insurance Programs for providers that need to enroll. It is up to the Managed Care Organization (MCO) to contact these providers to enroll. The public can access this list on Health Data website.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

How often do you recommend doing a batch upload to check Medicaid eligibility?

It is possible to do batch uploads daily, however this is not recommended. Your organization should determine how often is worthwhile (cost vs. benefit) based on the error rate you are getting. It is a best practice to check the individual’s Medicaid status prior to service delivery and as close to the appointment as possible (e.g. the morning of the scheduled appointment, night before, etc.).

Source: July 2018 CFTSS Billing In-Person Training

How do you become a Medicaid provider as part of an agency?

Both the organization where care is being provided and identified licensed practitioners individually need to be enrolled as Medicaid providers in order to bill Medicaid if the individual is an enrollable provider type. 

Any individual practitioner can obtain an NPI number, but only certain practitioner types may enroll in Medicaid to obtain an MMIS number. 

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Source: July 2018 CFTSS Billing In-Person Training

Is the date that medical necessity is determined considered the “admission date”?

The admission date is the earliest date the service is delivered.

Source: State January Roundtable 2019

Can a child/youth receive CFTSS services after they turn 18 and become eligible for some adult services? Can a 19 year old start to receive adult services and then decide CFTSS would suit them better and return to CFTSS until they age out?

Yes, children ages 0-21 who are in Medicaid are eligible to receive CFTSS (assuming they meet medical necessity). This includes children ages 18-21 who may also be (or have been) involved in adult services as long as there is no duplication of services. For more on allowable service billing combinations see the billing manual pages 15-17. 

Source: YPST Webinar 11.18.19

Do OPRA requirements apply to Article 29-I Facilities?

Yes. If the individual licensed practitioner is Medicaid enrollable, they must enroll and use their individual NPI number on claims.

If the individual practitioner is unlicensed or not a licensed enrollable Medicaid practitioner the OCFS (05448682) unlicensed practitioner ID may be used.

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Source: 2.10.21 Article 29-I Billing Office Hour

Is there a list of Managed Care Organizations (MCOs) in each region?

Please see the MCTAC Matrix for further information on MCOs in each region.

Source: Contracting

With multiple payers and multiple contracts how can small organizations survive and even thrive?

Small providers should start with where they are and what resources they have. Utilize board members to help with certain tasks or get further financial commitment from the board to help with the process of contracting and preparing for managed care services. In other states, nonprofits have formed affiliations, partnerships or collaborations to use shared infrastructure to help with tracking outcomes, billing, etc.

Source: Contracting

What is the definition of "recovery-based"?

A recovery-based mental health system embraces the following values: self-determination, empowering relationships based on trust, understanding and respect, meaningful roles in society, and elimination of stigma and discrimination.

The Substance Abuse Mental Health Services Administration, or SAMHSA, offers additional information here.

Source: Managed Care 101 7.22.15

What is Level of Care for Alcohol and Drug Treatment (LOCADTR)?

LOCADTR is the patient placement criteria system that must be used in making substance use disorder (SUD) level of care decisions in New York State (NYS). LOCADTR assesses the intensity and need of services for an individual with an SUD. All OASAS providers and Medicaid plans will be required to use this tool.

Additional information can be found on OASAS' website.

Source: MCTAC Kick-Off Forum, 1.23.14

What is a Medical Loss Ratio (MLR)?

In New York, the state has imposed an MLR of 89% for its Medicaid Managed Care program. This means that 89 cents of every dollar that flows from the state to the MCOs must be used to pay providers for services and not MCO administrative or marketing costs. If this figure is not met, funds return to the state and a legal process follows. The goal of this standard is to get behavioral health dollars out to providers.

Source: UM for OASAS Programs, 10.5.15 AM Session