Mandated Rate Update: ACT Reimbursement and Billing Changes
IMPACTED PLANS: Medicaid, HIV SNP, MAP and HARP
DATES: 10/01/2023 (Retroactive) and January 1, 2025 (Prospective)
RE: ALL BEHAVIORAL HEALTH PROVIDERS
Effective 10/01/2023 (Retroactive), OMH has released guidance to provide an overview of the billing, reimbursement and rate changes for ACT services.
I. ACT Reimbursement and Billing Changes for Adults:
1. 100 Slot ACT will be established for adults
a. A new rate will be established for 100 Slot Adult ACT teams
2. The 36 Slot ACT teams will receive a rate increase
II. ACT Reimbursement and Billing Changes for Youth:
3. The following Youth ACT Slot changes are implemented:
a. 28 Slot ACT teams will be established for Youth
b. Current 36 Slot Youth ACT teams will be converted to 28 Slot ACT teams
c. Current 48 Slot Youth ACT teams will be converted to 36 Slot ACT teams
4. All Youth ACT providers receive adjusted rates retroactive for these converted slots.
Prospective Rate Code Changes for Youth ACT Teams
Effective January 1, 2025, new rate codes (4513-4515), procedure codes and modifier combinations for Youth ACT only will be utilized to differentiate Adult and Youth ACT programs and allow the State to collect better data on utilization of service.
Table 1: Updated Youth ACT Coding Taxonomy
NOTE: Adult and Youth ACT providers will now be required to report the actual number of units on the claim (previously only required to report 1 unit) to support the State’s monitoring of service utilization.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].
