eFMAP Rate Changes for Children's Services

  • Announcement is also available in Portable Document Format (PDF)

TO: Medicaid Managed Care Plans and HIV Special Needs Plans (MMCPs), Children and Family Treatment and Support Services (CFTSS) Providers, Voluntary Foster Care (VFCA) 29-I Health Facilities, and Home and Community Based Services providers:

RE: Changes Regarding Rates for Children's Services Date: February 18, 2022

CFTSS and 29-I Health Facility Core Services:

This notice is to announce anticipated Children and Family Treatment and Support Services (CFTSS) and 29-I Health Facilities Core Per Diem rate adjustments during the COVID-19 Emergency as part of the American Rescue Plan Act of 2021 (ARPA), Section 9817, and assist impacted entities to plan for receipt of these funds. The NYS HCBS Spending Plan proposed to the Centers for Medicare and Medicaid Services (CMS) has been partially approved. A copy of the NYS HCBS Spending Plan, Quarterly Updates to the Spending Plan, and other pertinent information regarding ARPA, Section 9817 may be found at the following website: https://health.ny.gov/health_care/medicaid/redesign/hcbs/enhanced_funding/

This announcement is to notify Medicaid Managed Care Plans and HIV Special Needs Plans (MMCPs), CFTSS providers, and 29-I Health Facilities, that rates for Children's CFTSS and 29-I Core Services are anticipated to be increased by 25 percent.

  • For CFTSS, this 25 percent adjustment will be retroactive to April 1, 2021, through September 30, 2022, for services provided to members in Medicaid Fee-for-Service or Medicaid Managed Care.
  • For 29-I Health Facility Core Services, this 25 percent adjustment will be retroactive to July 1, 2021, through September 30, 2022, for services provided to members in Medicaid Fee-for-Service or Medicaid Managed Care.
Dates of Service for which the Rate Adjustments and Base Rates Apply
Program Previous Adjustments 4/1/2021 - 9/30/2021 10/1/2021 - 3/31/2022 4/1/2022 - 9/30/2022 Links to Rates
  Pending Additional Approval by CMS
Children and Family Treatment and Support Services (CFTSS) 11% rate adjustment effective 4/1/2020 – 3/31/2022 Retroactive 14% rate adjustment Retroactive 14% rate adjustment 25% rate adjustment OLP, CPST, PSR FPSS, YPS CI

Program 7/1/2021 - 9/30/2021 10/1/2021 - 3/31/2022 4/1/2022 - 9/30/2022 Links to Rates
  Pending Additional Approval by CMS
Article 29-I Health Facility Core Limited Health Related Services (per diem) Retroactive 25% rate adjustment Retroactive 25% rate adjustment 25% rate adjustment 29-I **
** This rate sheet on the DOH website will be updated to reflect the information in this chart

MMCPs should update their payment systems to pay the new rates no later April 18, 2022. MMCPs must configure their payment systems to retroactively adjust previously adjudicated CFTSS claims with dates of service on or after April 1, 2021, and 29-I Core Services claims with dates of services on or after July 1, 2021.

For Medicaid FFS, the adjusted CFTSS rates have been loaded in eMedNY and will take effect in Medicaid cycle 2324. Providers' previously paid CFTSS claims will be automatically adjusted and payment for the retroactive adjustment will be released on March 23, 2022. Providers and plans will be notified when Medicaid FFS rates for 29-I Health Facility Core Services are loaded in eMedNY.

Home and Community Based Services (HCBS):

The Department has received all necessary approvals to implement the Children's Home and Community Based Services (HCBS) rate adjustments that Medicaid Managed Care Plans and HIV Special Needs Plans (MMCPs) were notified of on December 15, 2021. Plans must immediately implement updates to their payment systems to pay the adjusted Children's Waiver HCBS and to ensure retroactive payments to HCBS' providers for previously adjudicated claims with dates of service on or after April 1, 2021, no later than March 31, 2022.

Dates of Service for which the Rate Adjustments and Base Rates Apply
Program Previous Adjustments 4/1/2021 - 9/30/2021 10/1/2021 - 3/31/2022 4/1/2022 - 9/30/2022 Links to Rates
  Approved by CMS
Home and Community-Based Services (HCBS) N/A Retroactive 25% rate adjustment Retroactive 25% rate adjustment 25% rate adjustment HCBS

The adjusted Children's Waiver HCBS rates have been loaded in eMedNY and will take effect in Medicaid cycle 2324. Providers' and plans' previously paid HCBS claims will be automatically adjusted and payment for the retroactive adjustment will be released on March 23, 2022.

As a reminder, MMCPs are required to pay State rates for these services and should refer to the May 27, 2020 notice Reminder: State Mandated Provider Rates vs MMC ATB from the New York State Department of Health.

Questions should be submitted to BH.Transition@health.ny.gov.