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.
Adult Behavioral Health Managed Care Timeline -see DOH website on Behavioral Health
July 2015 - First Phase of HARP Enrollment Letters Distributed (see below for an explanation of initial enrollment process)
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
Rest of State Implementation
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
Children´s Behavioral Health Managed Care Timeline
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
Explanation of Initial Enrollment Process (this is directly copied from State MRT webpage on Behavioral Health)
For More Information -
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
State webinars and policy - webinar held Nov. 6, 2015 should be posted here
FAQs - DOH - October 2015
FAQs for Consumers - DOH - Sept. 2015
NYS Policy Paper on Behavioral Health Transition (Oct. 1, 2015)
NYS Office of Mental Health - Policy & Guidance for Plans and Providers
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