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:
Do we need to receive designation to provide Children's CFTSS/HCBS before we enroll for a provider number such as the Medicaid Management Information System (MMIS)?
Yes, you need to receive designation to provide Children and Family Treatment and Support Services (formerly SPA) and/or Children's HCBS before you enroll for a provider number such as the Medicaid Management Information System (MMIS).
If an agency offers Adult Behavioral Health Home and Community Based Services (BH HCBS), are they eligible to enroll as a Medicaid provider?
Adult BH HCBS is not an enrollable practitioner or agency type.
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.
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.
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.