Enrollment, including the use of a Medicaid provider identification number, is

Medicaid regulations at 18 NYCRR §502.2 define ownership or control interest as a person or corporation that:

• has an ownership interest totaling five percent or more in a disclosing entity;
• has an indirect ownership interest equal to five percent or more in a disclosing entity;
• has a combination of direct and indirect ownership interests equal to five percent or more in a disclosing entity;
• owns an interest of five percent or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least five percent of the value of the property or assets of the disclosing entity;
• is an officer or director of a disclosing entity that is organized as a corporation; or
• is a partner in a disclosing entity that is organized as a partnership.

Each provider and fiscal agent

• the name and address of each person with an ownership or control interest in the disclosing entity or in any subcontractor in which the disclosing entity has direct or indirect ownership of five percent or more or who is a managing employee in the disclosing entity;
• whether any of the persons named is related to another as spouse, parent, child or sibling; and
• the name of any other disclosing entity in which a person with an ownership or control interest in the disclosing entity also has an ownership or control interest.

Questions? Please contact

Children younger than age 19 may now become presumptively eligible for Medicaid if assessed by a State-designated Qualified Entity (QE).

Presumptive eligibility is determined by QEs through a screening. Children who appear eligible based on the screening may receive all Medicaid covered care and services, until a full Medicaid eligibility determination is made by their local department of social services.

Medicaid providers may encounter children determined presumptively eligible, but who are not in possession of a Benefit Identification Card or a Medicaid Client Identification Number (CIN). These children will have a letter, from the QE, indicating they are presumptively eligible for Medicaid and are therefore entitled to Medicaid coverage.

The QE that screened the child will be given a CIN once an ongoing Medicaid determination has been made. The CIN will be used for billing during the presumptive period. Providers may obtain this CIN from the QE.

Questions? Please call the

If you are enrolled in more than one category of service, you are receiving more than one Medicaid Update. We can eliminate this duplicate mailing.

Please mail to us the address page of the duplicate copies of the Medicaid Update to:

Policy and Billing Guidance.......

When procedures are performed for the primary purpose of rendering an individual incapable of reproducing, the patient must have been informed of the risks and benefits of sterilization and have signed and received a copy of the

The completed and signed Sterilization Consent Form must be attached to the claim form and submitted with all surgeon, anesthesiologist and facility claims for sterilizations. Hospitals and Article 28 clinics submitting claims electronically must maintain a copy of the completed Sterilization Consent Form in their files.

The sterilization consent form is available in both English and Spanish at:

http://www.health.state.ny.us/health_care/medicaid/publications/ldssforms

When completing the Sterilization Consent Form:

• Be certain that the form is completed so it can be easily read. An illegible or altered form is unacceptable (and will cause a paper claim to deny).
• Ensure that the form is signed and dated by the individual to be sterilized and the physician who performed the procedure.
• Complete each required field in order to ensure payment.
• Include the Consent Form.

Claims without a properly completed Sterilization Consent Form will not be processed for payment. In conformance with the 2006 New York State Surgical and Invasive Procedure Protocol, claims signed by the patient on or after

http://www.health.state.ny.us/professionals/protocols_and_guidelines/surgical_and_invasive_procedure/docs/protocol.pdf

Refer to the Billing Section of your Provider Manual for additional completion instructions.

Questions? Please call the

When billing for compounded prescriptions using the individual NDC code:

• Each ingredient must have a unique prescription number.
• Initial ingredient should be identified using the prescription serial number from the official New York State prescription form.
• Subsequent ingredients should be identified by using

Questions? Please call

Effective

For more information about other preventive vaccines covered by Medicare Part D, the provider should contact the patient's Medicare Part D prescription plan.

Questions? Please call the < Bureau of Policy Development and Coverage

Medicaid regulations now allow occupational therapy assistants and physical therapist assistants to qualify as professionals that can provide rehabilitative services to Medicaid enrollees. The full text of the regulation is available at the Department's website: www.nyhealth.gov/regulations/nycrr/title_18/ (search Title 18, and type in 505.11).

Physical Therapy

Physical therapy services may be billed when:

• The physical therapist or physical therapist assistant is licensed or certified, respectively, < and New York State Education Department.
• There is appropriate supervision, meeting requirements identified by the State Education Department, of the physical therapist assistant by the physical therapist.
• Physical therapy services are provided on a one-to-one basis with the patient and the physical therapist or physical therapist assistant.
• The patient encounter must last for a

A

Occupational Therapy

Occupational therapy services may be billed when:

• The occupational therapist or occupational therapy assistant is licensed or certified, respectively,
• There is appropriate supervision, meeting requirements identified by the State Education Department, of the occupational therapy assistant by the occupational therapist.
• Occupational therapy services are provided on a one-to-one basis with the patient and the occupational therapist or occupational therapy assistant.
• The patient encounter must last for a < minimum of 15 minutes

A

Questions? Please call the

Federally Qualified Health Centers (FQHCs) will receive a notification letter regarding the addition of

Effective for dates of service on or after

<* Group psychotherapy and off-site visits are only reimbursable to FQHC clinics.

Providers may

Questions concerning FQHC payment policy should be directed to
the

The February 2008 Medicaid Update contained an article entitled "Clarification of Commercial Insurance Billing Requirement". The article contained billing guidance regarding Medicaid payment in situations where the provider contracts or does not contract with a commercial insurance payer.

The table below shows the < rate code 2996 <2946.

Providers can access the Service Intensity Weight (SIW) table for New York State hospitals at:

www.health.state.ny.us/facilities/hospital/drg/drgs.htm

Questions? Please call the

Providers will be notified when the following options are available:

Pharmacy Providers

A pharmacy will have the ability to identify when it is billing Medicaid for a 340B drug by entering a value of 09 in field 423-DN, basis of cost determination, using NCPDP version J.1.

Ordered Ambulatory Providers

Hospitals and clinics will have the ability to identify when they are billing Medicaid for a 340B drug by entering a value of UD when using the product service qualifier-loop 2400, SV2 segment, data element SV202-3 through SV202-6 on the 837I electronic format.

Questions? Please call the < Bureau of Pharmacy Policy and Operations

Prescriptions written on or after

• <Growth Hormones
• <Erythropoiesis Stimulating Agents
• <Progestins (for Cachexia)
• <Carbamazepine Derivatives
• <Ophthalmic Non-Steroidal Anti-Inflammatory Drugs
• <Ophthalmic Alpha-2 Adrenergic Agonists.

The current Preferred Drug List may be found on the following sites:

https://newyork.fhsc.com/   or   http://www.emedny.org/

To obtain prior authorization for a

<(877) 309-9493
and follow the appropriate prompts.

Requests for prior authorization of non-preferred drugs may also be faxed to:

<(800) 268-2990.
Faxed requests may take up to 24 hours to process.

The prior authorization worksheet/fax form can be found at:

https://newyork.fhsc.com/providers/PDP_forms.asp

<The New York State Medicaid Preferred Drug List

is available at the following website:

https://newyork.fhsc.com/

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• Day Treatment;
• Day Habilitation and Residential Providers;
• Intermediate Care Facilities;
• Supervised Community Residences and
• Supervised and Supportive Individualized Residential Alternatives

Transportation providers may not separately bill Medicaid for transportation as described in this article.

Responsibility for Transportation Provider Reimbursement
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Office of Mental Retardation and Developmental Disabilities (OMRDD) Day Treatment and Day Habilitation agencies must provide or pay for transportation to and from their programs using their day program reimbursement.

OMRDD certified Intermediate Care Facilities (ICF/DDs), Supervised Community Residences, and Supervised and Supportive Individualized Residential Alternatives must provide or pay for all resident transportation to medical and clinical appointments,

Ambulance service should

Questions? Please contact karla.smith@omr.state.ny.us

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Ambulance Providers

Obtaining Payment May Require a Medicaid Subrogation Notice
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When a Medicaid enrollee has

Questions? Please call the the

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PROVIDER SERVICES
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The Medicaid Update, now indexed by subject area, can be accessed online at the New York State Department of Health website:

http://www.nyhealth.gov/health_care/medicaid/program/update/main.htm

Hard copies can be obtained upon request by emailing: medicaidupdate@health.state.ny.us

http://www.omig.state.ny.us (518) 473-3782

Each article contains a contact number for further information, questions or comments.

Please contact CSC Provider Services at: (800) 343-9000.

To sign up for a provider seminar in your area, please enroll online at:

http://www.emedny.org/training/index.aspx

For individual training requests, call (800) 343-9000 or email:

emednyproviderrelations@csc.com

Call the Touchtone Telephone Verification System at any of the numbers below:

(800) 997-1111    (800) 225-3040      (800) 394-1234.

Questions should be directed to CSC at: (800) 343-9000.

• A change of address form is available at:        http://www.emedny.org/info/ProviderEnrollment/index.html
• A change of address form is available at:       http://www.emedny.org/info/ProviderEnrollment/index.html

Please contact the editor, Kelli Kudlach, at:      medicaidupdate@health.state.ny.us

<Medicaid Update is a monthly publication of the New York State Department of Health containing information regarding the care of those enrolled in the Medicaid Program.