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Office of Mental Health

Behavioral Health Managed Care Phase 2

Behavioral Health Managed Care Transition

The vision for Phase 2 is to create a system that provides New Yorkers with fully integrated behavioral health and physical health services offered within a comprehensive, accessible and recovery oriented system. For adults 21 and older, the integration of all Medicaid behavioral health (BH) and physical health (PH) benefits under managed care will go into effect January 2015 in NYC and July 2015 in the rest of New York State and will be delivered through two BH managed care models:

Stakeholder Engagement

In an effort to engage stakeholders in the design and delivery of the behavioral health managed care model, OMH, in partnership with DOH and OASAS, continues to meet with Managed Care Plans, Provider Associations, families and consumers regarding this important behavioral health transition from FFS to Medicaid Managed Care.

Additionally, OMH, OASAS, and DOH continue to meet with the MRT Behavioral Health Workgroup for input and feedback on the managed care design. All Medicaid Redesign Team (MRT) Behavioral Health Managed Care updates can be found through the MRT Behavioral Health Reform website Leaving OMH site.

Qualification Process

Before Phase 2 can be fully implemented, managed care plans will be required to submit applications to New York State demonstrating that they have the organizational capacity and culture to ensure the delivery of effective behavioral health care and facilitate system transformation. These applications will be reviewed against new behavioral health specific administrative, performance, and fiscal standards. The RFQ qualifies Plans to manage services on their own or in partnership with a Behavioral Health Organization.

NYS Request for Qualification Package

NYS released the Request for Qualification regarding “Behavioral Health Administration: Managed Care Organizations and Health and Recovery Plans”. Applications for Managed Care Organizations serving New York City are due by June 6, 2014. RFQ applications for Managed Care Organizations serving the rest of the state will be due approximately six months later.

This RFQ package includes the following items:

NYS has modified templates for Medicaid Managed Care Plan financial and enrollment projections. Instructions and templates can be found below. These documents were amended on 6/2/14.

On May 23, 2014 New York State released draft rate ranges for the Rest of State (ROS) HARP population, effective July 1, 2015. These rates can be found below.

Behavioral Health RFQ Applicant's Conference for New York City applicants

On May 2, 2014 Managed Care applicants and other interested parties participated in a Applicant's Conference where the State responded to questions on the RFQ for "Behavioral Health Benefit Administration: Managed Care Organizations and Health and Recovery Plans". The following materials were presented to attendees.

Written responses to inquiries not addressed at the RFQ Applicant’s Conference are posted below. All outstanding questions were responded to on 5/28/14. The revised document is located below.

Note: Response to question 45 was amended on 6/3. See below for amended FAQs:

Behavioral Health Billing Manual

  1. Final Draft Behavioral Health Billing Guidance PDF Document * – The first section of the document called “New York State HARP Mainstream BH Billing and Coding Manual” provides billing mechanics for all the Medicaid fee-for-service “government rate” services (including OMH licensed and OASAS certified services).  This should be reviewed in conjunction with attachments 2, 3, and 4.  The second section of the manual gives detailed information on OASAS services.  There are numerous links in this document, provided for your convenience.
  2. Coding Taxonomy Excell Document * – This file provides the required coding construct for billing the OMH government rates services. Government rates must be used for the first 24 months of the behavioral health carve-in.  Plans will need to program their payment systems to accept these coding combinations and then look through the Rate Table to ascertain the correct payment amount for the various unique coding combinations (specified using procedure codes, modifier codes, and units of service - all cross-walking to rate code) and the specific provider and BH service (based on MMIS provider ID or NPI and rate code).
  3. HCBS fee schedule Excell Document * – This shows the required coding combinations for providers to bill the Plan for the provision of these services.  The rate codes that the Plans will use to receive reimbursement from eMedNY will be provided in the near future and are subject to CMS and NYS DOB approval.
  4. Rate Table Excell Document * – This will have to be built into the Plan’s payment system.  It shows the rate amount for each MMIS provider ID and rate code combination.
  5. HARP HCBS Rate Codes PDF Document - These are the codes that the HARP plans and HSNPs will be using to bill Medicaid for HCBS services that are provided to HARP enrollees (or HSNP enrolled HARP-eligibles).

* If you are having accessibility issues with the previous documents, please contact Omer Jirdeh, or call (518) 473-4144.

Please contact OMH Managed Care with any questions, comments or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint Page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.