Notification to Medicaid Managed Care Plans (MMCPs) regarding non- risk minimum payments for Children's Home and Community Based Services (HCBS)
- Update also available in Portable Document Format (PDF)
To: Medicaid Managed Care Plans (MMCPs) including Mainstream Medicaid Managed Care and HIV Special Needs Plans and Children's Waiver Home and Community Based (HCBS) Providers
DATE: October 18, 2024
UPDATE: The purpose of this announcement is to provide additional information regarding Children's Waiver policy changes effective October 1, 2024. Updates are highlighted in yellow.
Effective October 1, 2024, Medicaid Managed Care Plan (MMCP) capitation payments will be adjusted to include risk-based premium adjustments for Children's Waiver HCBS, excluding Environmental Modifications (EMods), Vehicle Modifications (VMods), Assistive and Adaptive Technology (AAT) and Non-Medical Transportation (NMT), which will be carved out of the managed care benefit package and reimbursed through Fee-for-Service (FFS). Any EMod, VMod, or AAT projects that are still being managed by the MMCP and not yet complete must be billed with a Date of Service on or prior to October 1, 2024 upon project completion. HCBS rate codes were disabled effective October 1, 2024. Children's HCBS providers will continue to submit claims using established Department of Health billing codes outlined in the Children's HCBS Provider Manual.
Since October 1, 2019, when Children's Waiver HCBS were added to the Medicaid Managed Care benefit package, MMCPs were required to pay, at minimum, government rates for Children's Waiver Home and Community Based Services (HCBS) and MMCPs have been reimbursed for these services via non-risk payments outside of the capitation rate. Effective October 1, 2024, MMCPs will no longer be reimbursed via non-risk payments for Children's HCBS. However, MMCPs must continue to pay providers, at minimum, government rates for all Children's HCBS.
Questions related to this notification can be sent to BH.Transition@health.ny.gov
