GIS 17 MA/012: Restriction/Exception Code 83 Alcohol and Substance Abuse
To: Local District Commissioners, Medicaid Directors, Temporary Assistance Directors
From: Jonathan Bick, Director
Division of Health Plan Contracting & Oversight
Subject: Restriction/Exception Code 83 Alcohol and Substance Abuse
Effective Date: Immediately
Contact Person: Managed Care
Upstate (518) 473-1134
The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) that Restriction/Exception Code 83 (alcohol and substance abuse) is no longer applicable for adults mandated into drug and alcohol treatment by Temporary Assistance. Effective immediately, local districts should no longer enter this code for anyone 21 years of age or older.
Restriction/Exception Code 83 enabled fee-for-service payment of drug and alcohol treatment for enrollees in Medicaid managed care plans. However, as part of the implementation of behavioral health benefits into Medicaid managed care, effective 10/1/15 in NYC and 7/1/16 Rest of State, Medicaid managed care health plans, including Special Needs Plans (SNPs) and Health & Recovery Plans (HARPs), are required to cover local district mandated behavioral health services for their adult enrollees. Therefore, it is no longer appropriate to use Restriction/ Exception Code 83.
If you have any questions, please contact managed care at mcsys@health.ny.gov or your local district liaison.
