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).

RE: Billing Guidance for Delivering Services in a Language Other Than English (LOE) Within MHOTRS Programs

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.


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.


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.


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

The New York State Department of Health has updated the coverage policy and billing guidance document regarding New York State Medicaid’s reimbursement policy for the administration of COVID-19 vaccines. This guidance can be found on the COVID-19 Guidance for Medicaid Providers ( webpage, which is updated regularly.

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.


Dear Valued Provider:

If you don’t help your patients act soon, they will lose their Medicaid coverage. While Medicaid members were automatically renewed over the Pandemic, the Public Health Emergency ended in May and enrollees must now go through a rigorous and complex redetermination process to keep their Medicaid coverage.

All members in the following MetroPlusHealth Plans are impacted:

  • Medicaid Managed Care
  • Child Health Plus (CHP)
  • Essential Plan
  • Enhanced (HARP) Plan
  • Partnership in Care (PIC) HIV SNP
  • UltraCare (MAP)

Losing coverage will mean disruption of care, negatively impacting the health of your patients, a decline in your patient roster, the potential for claim denials due to eligibility and a negative impact on incentive-based rewards.

5 things all Healthcare Providers of care can do today:
1. Direct members to MetroPlusHealth Customer Success Specialist via phone at 212.908.3300 or online at
2. Utilize all patient interactions to remind patients of the need to renew coverage
3. Make use of MetroPlusHealth’s recertification collateral (brochures, banners, fliers, etc.) Providers can send an email to [email protected] to request these materials.
4. Ensure front line staff are verifying recertification dates during registration, scheduling, etc. so there is no gap in coverage. Front line staff should re-familiarize themselves with the recertification process, including documentation needed to submit for member renewal as members will be receiving notices regarding renewal which will result in increased questions and requests for assistance.
5. Primary Care Practices can get a roster of their MetroPlusHealth members with the recertification date by logging in to the Provider Portal at

Questions? The Provider Call Center can help. Call 800.303.9626.

Thank you, as always, for all you do to support our members.


IMPORTANT REMINDER: Prescription Monitoring Program Registry

Effective August 27, 2013, most prescribers are required to consult the Prescription Monitoring Program (PMP) Registry when writing prescriptions for Schedule II, III, and IV controlled substances. The PMP Registry provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for their patients. The PMP is available 24 hours a day/7 days a week via an application on the Health Commerce System (HCS) website. Patient reports will include all controlled substances that were dispensed in New York State and reported by the pharmacy/dispenser for the past year. This information will allow practitioners to better evaluate their patients’ treatment with controlled substances and determine whether there may be abuse or non-medical use. If a Provider is unable to conduct a PMP check, the Provider should document a good faith effort, including the reason why the Provider is unable to conduct a PMP check. For questions related to the Prescription Monitoring Program, the NYS Department of Health Bureau of Narcotic Enforcement has a toll-free number that you can call: 1-866-811-7957 or visit here for more information.


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

Member and Provider FAQs - Pharmacy Benefit Carve-Out

Important reminder to Our Providers Regarding our National Drug Code (NDC) Requirement Policy, Professional and Facility

The Deficit Reduction Act of 2005 (DRA) requires Medicaid agencies to collect NDC numbers on pharmaceuticals. Our NDC billing requirements for providers enrolled in the 340B Program can be found here.

Read our NDC billing requirements for 340B Program providers here.

last updated: December 15, 2023

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