New York State Department of Health Updates:

Partnership in Care Rewards Program

Tell your patients living with HIV about the MetroPlusHealth Rewards Program. Your patients enrolled in Partnership in Care can get rewarded for health screenings and activities. There is even a substantial reward just for attending clinic appointments for their HIV care. Learn more about the program here.

IMPACTED PLANS: MEDICAID, AND HIV SNP

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).

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.

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.

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.

Our goal is to give our Providers help finding and managing day-to-day needs. Please contact Provider Services at 1-800-303-9626 (TTY: 711) or Medicare at 1-866-986-0356 if you need help or have questions.

Register or get directed to online trainings through the calendar.

PROVIDER EDUCATION AND TRAINING

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 (ny.gov) webpage, which is updated regularly.



HELP PATIENTS PREVENT DIABETES WITH LIFESTYLE TIPS

Here are some lifestyle steps your patients can take to help reduce blood sugar levels and prevent diabetes:

Shed weight.

Losing weight can feel overwhelming for many patients. But it doesn’t take much to help improve their health. Shedding just 7% of body weight has been proven to lower the risk of diabetes. Move more.

Aim to get 30 minutes of exercise on most days — or 150 minutes a week — to help ward off chronic disease. Tweak diet choices Limit added sugars and choose whole foods instead of processed foods like chips, boxed dinners, and fast food. Non-starchy vegetables like carrots, broccoli, and spinach as well as lean meats and fish can help keep blood sugar stable.

Prioritize sleep.

Patients should aim for seven to eight hours of quality sleep every night. Good sleep can lower the risk of insulin resistance, which can lead to high blood glucose levels.

Follow up.

Follow up with patients yearly to check blood sugar levels and ensure they are taking proactive steps to prevent diabetes. It’s estimated that 80% of people with prediabetes are unaware they have it.

DIABETES RESOURCES

Patients who participate in American Diabetes Association diabetes self-management education and support (DSMES) are more likely to manage their health and take medicines as prescribed. To learn more, click here.


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 at:
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.


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.
For more information.


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

Read More

IMPORTANT MESSAGE TO OUR PROVIDERS: PCP IN-OFFICE NON-ALLOWABLE SERVICES

Effective April 15, 2022
The Primary Care Provider (PCP) In-Office Non-allowable services list is a compilation of procedure codes MetroPlusHealth deems non-allowable for reimbursement to our Network PCPs (Family Practice, Internal Medicine, Pediatrics, Geriatrics and Adolescent Medicine). MetroPlusHealth PCP non-allowable in-office services list will go into effect on April 15th, 2022. Click here to learn more and for the list of impacted codes.


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.


IMPORTANT NOTICE TO OUR PEDIATRIC PRIMARY CARE PROVIDERS REGARDING 2023 ENHANCED CHILDREN’S BENEFITS:

MetroPlusHealth has been ramping up for the expansion of services that will become available to children and youth in 2023. Learn more here about new benefits and services coming in 2023.


IMPORTANT NOTICE TO OUR APPLIED BEHAVIORAL ANALYSIS (ABA) PROVIDERS REGARDING 2023 ABA BENEFIT CHANGES

MetroPlusHealth has been ramping up for the expansion of Applied Behavior Analysis Services to eligible Medicaid members diagnosed with autism spectrum disorder. Services will become available January 1, 2023, for those members under 21 years of age. Learn more here about new benefits and services coming in 2023.


IMPORTANT NOTICE: THE PROVIDER DUE DATE FOR COMPLETION OF THE MODEL OF CARE TRAINING IS DECEMEBER 31, 2023. CLICK HERE TO ACCESS THE ONLINE TRAINING.

You can access the digital attestation form here.


IMPORTANT MESSAGE ANNOUNCING AN END OF YEAR BONUS PAYMENT FOR OUR PROVIDERS IN ASSISTING MEMBERS TO OBTAIN THEIR KEY WELLNESS TESTS/VISITS.

This incentive is separate from our Pay for Performance (P4P) Program. Learn more here.


IMPORTANT NOTICE TO 1915(c) CHILDREN’S WAIVER RESPITE HCBS PROVIDERS:

The New York State Department of Health is evaluating various policy flexibilities allowed during the COVID-19 Public Health Emergency (PHE) and determining which flexibilities will be ending and which ones will be extended (temporarily/permanently).

Effective January 1, 2023, the Children’s Respite Services flexibility will end and providers are required to revert to the original guidance provided in the HCBS Manual.  Read the guidance here.


IMPORTANT NOTICE: PHARMACY BILLING GUIDANCE EXCEPTIONS FOR NON-ENROLLED PRESCRIBERS

The New York State (NYS) Medicaid program requires enrollment of all licensed prescribers and pharmacies who serve Medicaid members, including prescribing practitioners identified on pharmacy claims per the Centers for Medicare and Medicaid Services (CMS) and federal regulations. However, under the Medicaid Provider Enrollment Compendium (MPEC) found here: https://www.medicaid.gov/medicaid/program-integrity/affordable-care-act-program-integrity-provisions/index.html, there are two exceptions to the provider enrollment requirement that are allowed. Learn more here.


IMPORTANT NOTICE REGARDING PT AND OT VISITS

Effective January 1, 2023, the number of visits allowed without prior authorization for both Physical Therapy (PT) and Occupational Therapy (OT) will change. Ten (10) visits will be allowed without prior authorization, inclusive of the initial evaluation.

Effective January 1, 2023, all Speech Therapy and Chiropractic Care will require prior authorization. There will be no visits allowed without prior authorization.

Overall benefits allowed vary by Line of Business (LOB), so it is important to verify both LOB and eligibility prior to rendering services.  Click here to learn more about facilitating review when requesting visits for PT or OT.


 

COVID-19 Guidance for 1915(c) HCBS Children’s Waiver for Children’s Health Homes, C-YES, HCBS, and MMCP/HIV SNP

last updated: January 24, 2025

Become a Provider

Sign up in a New York minute.

Find it. Do it. Faster.

Already A Provider?

Talk To Us About Any Questions or Concerns

Monday–Friday | 8 a.m.–6 p.m. (ET)