As part of the Children’s Medicaid System Transformation, New York State intends to implement six new behavioral health services under the Early and Periodic Screening and Diagnostic Testing benefit in the Medicaid State Plan. These newly established services will offer new community-based supports to Medicaid-enrolled individuals under the age of 21 who meet medical necessity criteria. The six services are:
- Other Licensed Practitioner (OLP);
- Crisis Intervention (CI);
- Community Psychiatric Supports and Treatment (CPST);
- Psychosocial Rehabilitation Services (PSR);
- Family Peer Support Services (FPSS); and
- Youth Peer Support and Training (YPST).
Pending Federal and State approval, it is expected that the OLP, CPST, and PSR services will be implemented beginning January 1, 2019; FPSS services on July 1, 2019; and YPST and CI services as of January 1, 2020.
In June 2018, the State released an updated Children and Family Treatment and Support Services Provider Manual that includes guidelines for medical necessity criteria and utilization management for the new services. The State intends for Medicaid managed care organizations to use the document to develop policies for these services. The State intends for plans not to use more restrictive criteria than these guidelines.
A summary of the updated provisions and medical necessity requirements for each of the new services is attached. The Provider Manual can be found here.