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NEW YORK STATE MEDICAID COVERAGE OF RESPIRATORY SYNCYTIAL VIRUS MONOCLONAL ANTIBODY (NIRSEVIMAB) FOR INFANTS
Effective October 1, 2023, New York State (NYS) is providing coverage for the administration of Nirsevimab for infants through the Vaccines for Children (VFC) program.
Nirsevimab is a monoclonal antibody preparation for the prevention of Respiratory Syncytial Virus (RSV) in infants, as recommended by the Advisory Committee on Immunization Practices (ACIP) of the Center of Disease Control and Prevention (CDC).
Impacted Plans: Medicaid, HARP, HIV SNP, AND MAP
Effective October 1, 2023, The NYS Office of Mental Health (OMH) and the NYS Department of Health (DOH) have updated the billing guidance for delivering interpreter services in an LOE (Language Other Than English), including American Sign Language within a OMH MHOTRS Program. This updated guidance establishes an additional new modifier combination to obtain an enhanced reimbursement when translation services are provided by a vendor or any translation professional, other than a MHOTRS staff person.
APPROVAL OF THE NOVAVAX COVID 19 VACCINE
Effective October 3, 2023, the Federal Drug Administration (FDA) announced the approval of the updated 2023–2024 monovalent XBB.1.5 variant Novavax COVID-19 Vaccine, Adjuvanted.
COMMUNITY HEALTH WORKER SERVICES FOR PREGNANT AND POSTPARTUM MEMBERS
RETROACTIVE: Effective October 1, 2023, MetroPlusHealth will reimburse Community Health Worker (CHW) services* for pregnant and postpartum populations. Medicaid members are eligible for CHW services during pregnancy and up to 12 months after the end of pregnancy, regardless of how the pregnancy ends.
Self-Disclosure Notification Protocol
The Office of Mental Health (OMH) is informing Providers of their responsibility to notify OMH when a self-disclosure of a Medicaid overpayment is made to the Office of the Medicaid Inspector General (OMIG) using the Full Self-Disclosure Process.
Medicaid providers are required to report, return, and explain any overpayments they have received to the OMIG Self-Disclosure Program within sixty (60) days of identification, or by the date any corresponding cost report was due, whichever is later. Upon receiving this notice, the OMH Medicaid Compliance Office will review and issue a statement confirming that the oversight agency has been notified.
BILLING REQUIREMENT CHANGES AND UPDATES FOR CHILDREN’S HCBS AND CFTSS SERVICES
Effective December 1, 2023, NYS is implementing a billing change that will allow claims for Children’s Home and Community Based Services (HCBS) and Children and Family Treatment Support Services (CFTSS) to be paid based on the county in which services were provided, rather than a provider’s corporate headquarters or central office address.
NOTICE TO OUR PROVIDERS REGARDING New York State Medicaid’s reimbursement policy for administration of COVID-19 vaccines
Updated Provider Letter Regarding Foster Care 2023
As a MetroPlusHealth network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCA).
Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located here.
URGENT MESSAGE: YOUR PATIENTS WILL LOSE THEIR MEDICAID COVERAGE UNLESS THEY RENEW
IMPORTANT REMINDER: Prescription Monitoring Program Registry
PROVIDER SEMINAR: CANCER AND ENVIRONMENT
Wednesday, June 21st , 2023 | 9:30 AM – 5:00 PM
Roy and Diana Vagelos Education Center Auditorium & via Zoom
Join the Herbert Irving Comprehensive Cancer Center at Columbia University Irving Medical Center and the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine for a one-day CME event on the state of the science of environmental carcinogenesis and the role physicians, nurses, community leaders, and public health practitioners play in engaging on environmental chemicals and cancer risk reduction.
Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency
Comprehensive updated guidance regarding use of telehealth (including telephonic services) and billing guidance and criteria following the end of the Coronavirus Disease 2019 Public Health Emergency on May 11,2023, released by the New York State Department of Health, can be found here.
Providers must comply with the DOH, OMH, OASAS, and OPWDD issued Billing Updates to applicable codes, modifiers, and Place of Service (POS) requirements, for Medical and Mental Health Services.
Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
Rx Carveout
Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.
Information about the transition of the pharmacy benefit from MetroPlusHealth to NYRx, the Medicaid Pharmacy Program can be found here.
General information about NYRx, the Medicaid Pharmacy Program can be found here along with information for Members and Providers.
New Pharmacy Provider Training Videos Available
New videos have been posted to the eMedNY Provider Training Videos page. The video NYRx – Billing Medical Supplies has been added under the NYRx Pharmacy Program section.
You can view the video here
Effective date: February 2024
Provider Newsletters
Important reminder to Our Providers Regarding our National Drug Code (NDC) Requirement Policy, Professional and Facility
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