Cost-Effective Alternative Services (In Lieu of)

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Notification to Health Homes, Children's HCBS and CFTSS Providers, 29-I Health Facilities, and Medicaid Managed Care Plans and HIV Special Needs Plans (MMCPs) regarding 1% ATB Rate Increase and 5.4% COLA

To: Health Homes Serving Children and Adults, Children and Family Treatment and Support Services (CFTSS) Providers, Children's Home and Community Based Services (HCBS) Providers, 29-I Health Facilities, and Medicaid Managed Care Plans (MMCPs), including Mainstream Medicaid Managed Care and HIV Special Needs Plans

DATE: October 3, 2022

In accordance with the 2022-23 Enacted Budget, the 1% Across the Board (ATB) Medicaid Rate Increases effective for dates of service on or after April 1, 2022, have been loaded in eMedNY for Health Homes Serving Children and Adults. The chart posted on the DOH website outlines the services to which the 1% ATB rate increase applies.

Please Note: Care Coordination Organization Health Homes (CCO-HH) and Adult Health Home Plus (Adult HH+) are eligible for a 5.4% Cost of Living Adjustment (COLA) and are therefore excluded from the 1% ATB. These rates will be posted to the DOH website: Health Home Rate Codes in Effect for Health Home Services on/after April 2022 (ny.gov)

Additionally, final approval is being sought for the 1% Across the Board (ATB) Medicaid Rate Increases effective for dates of service on or after April 1, 2022, for the 29-I Health Facilities for the Core Limited Health Related (Per Diem) and Other Limited Health Related Services and the website will be updated.

DOH is seeking final approval of the 5.4% COLA Medicaid Rate adjustment effective for dates of service on or after April 1, 2022, including for Child and Family Treatment and Support Services (CFTSS), Children's Home and Community-Based Services (HCBS) and CCO-HH and Adult HH+.

Upon approval, the Children's CFTSS and HCBS rates, posted on the DOH website at the following links, will be loaded in eMedNY:

For services that must be paid at or above the government rates, plans should adjust their reimbursement rates accordingly.

All questions should be submitted to the following electronic mailbox: health.sm.ATB-reduction@health.ny.gov. Please include your provider's name and Medicaid number on the email so that questions may be reviewed by program area. Please access the website regularly for the most updated information.