Safety Net Determinations


1. HCBS/1915i Service Provider Lists

Providers on this list are agencies known to operate non-Medicaid reimbursable Home and Community Based-like services that are similar to or identical to the HCBS, also referred to as "1915i-like", services that will be available to Health and Recovery Plan (HARP) enrollees if HARPs are approved by CMS. Most are currently recipients of funds from OMH and/or OASAS to provide these services. Some are agencies known to OASAS as providers of these services that are funded through other than State sources.

The OMH/OASAS licensed agencies already listed as a "Safety Net Provider" on the DOH DSRIP website all qualified as safety net providers because their services to Medicaid and uninsured individuals represented more than 35% of their total volume of Medicaid reimbursable services. OMH/OASAS is submitting this list of agencies to DOH pursuant to the "exception process" discussed by DOH with CMS. If approved by CMS, these agencies will be provisionally added to the list of "safety net" providers, to be considered as safety net providers by the Performing Provider Systems (PPS) unless and until individual agencies are subsequently delisted (see following).

DOH, OMH/OASAS and OASAS will shortly be distributing HCBS service descriptions and proposed rates of reimbursement for these services, as well as instructions for providers desiring to be designated as approved HCBS service providers. All of the providers on this list appear qualified to be designated to provide one or more HCBS services to HARP enrollees, based on their experience delivering OMH/OASAS funded similar services.

Importantly, however, their appearance on this list is NOT tantamount to designation. These providers will have to apply for designation. Any provider on this list that does not apply to be an HCBS service provider and/or is not approved as an HCBS provider will be delisted as a "safety net" provider.

2. Harm Reduction Counseling Provider List

The New York State Department of Health AIDS Institute funds community agencies to provide non-Medicaid-funded harm reduction services to Medicaid-eligible people with substance use disorders (SUDs). These harm reduction services are vital to supporting these individuals who are living in community settings and preventing emergency room presentations and inpatient unit admissions and readmissions. By doing so, these harm reduction service providers support the Department's goals of decreasing unnecessary hospitalizations, including detox services and care for SUD-related physical health conditions. These harm reduction services cross a broad spectrum of supports and represent many community providers who are not currently eligible to be designated as a safety net provider in New York State's Delivery System Reform Incentive Payment (DSRIP) Program.

At this time, New York State is also seeking approval to provide 1915i services within the 1115 partnership plan. It is likely that in addition to the services these agencies currently provide, many will also be delivering some of the proposed Medicaid-funded 1915i home- and community-based services specifically designed to meet individuals' needs and maintain their community tenure. These agencies will provide direct Medicaid reimbursable services after the behavioral health care-in to Medicaid Managed Care but may be left out of the developing performing provider systems.

3. Health Home Lists

This list includes State designated health homes and downstream care management agencies. This list was created by the Department for your reference using calendar year 2012 and 2013 Medicaid data. Providers that billed $10,000 or more of health home and care management agency rate codes have been included.

4. Physician List

The Physician Safety Net Analysis originally based upon the data provided as part of the Meaningful Use initiative for Physicians which includes all Physicians who were determined to provide greater than 35% of their services to Medicaid recipients has now been updated for all appeals filed by August 27, 2014.

5. Pharmacy List

The Pharmacy Safety Net Analysis includes pharmacies that submitted Cost of Dispensing (COD) Surveys to the Department of Health (DOH) in September, 2012, and reported Medicaid FFS prescription volume as? 35% of the total volume and also reflect additional Pharmacies based upon appeals submitted by the August 27, 2014 deadline.