GOOD NEWS - The 2022-23 NYS Budget will END the use of Utilization Thresholds for Medicaid in July 1, 2022.
This fact sheet explains Medicaid Utilization Thresholds (MUTS or UT) in New York State - Limits on Number of certain services per year, and the "override" procedure available to increase these limits. the State Medicaid program will instead review utilization after services are already provided, to detect possible over-utilization. This is a big improvement from the cumbersome Threshold Override process.
NY Soc. Serv. L. ยง 365-g, amended by L. 2022 Ch. 57, Part W; 18 NYCRR Part 511.
The above fact sheet has not been updated since 2008 but is substantially still current - and will be unitl July 1, 2022
After July 1, 2022, instead of requiring a provider to request an "override" of the threshold number of lab tests, physician visits, etc.,
For more info see:
- The Utilization Threshold Program NYS Dept. of Health Fact Sheet 2/9/2015
- Threshold Override Application (TOA) NYS DOH Form (sample)
- eMEDNY Medicaid Provider Manuals See sections on Utilization Thresholds in individual manuals:
This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.
