State Updates
Governor Cuomo Announces Regional Reopening Requirements
Today (April 28th), Governor Cuomo held a press conference during which he announced the development of the “NY Forward Reopening Advisory Board,” which will be comprised of over 100 business, community, and civic leaders who will help guide the State’s reopening strategy (a full list of members is available here). The Governor provided new details on reopening protocols, including requiring each region to appoint an oversight institution as its “control room” to monitor regional metrics, such as:
- Hospital capacity;
- Rate of infection;
- Personal Protective Equipment (PPE) supply; and
- Business practices.
On hospital capacity, the State will require that at least 30 percent of hospital beds and intensive care unit (ICU) beds remain available in a region that has been approved to resume elective surgeries. For infection rate metrics, the State will require that the rate of transmission of the COVID-19 virus remains below 1.1 in a region. The State will also require regions to adequately advertise where people can get tested and have plans in place for isolation facilities with rooms for individuals who test positive for COVID-19 but cannot self-isolate. For regional contact tracing, the Governor said that programs should consider the regional infection rate and plan to have at least 30 contact tracers for every 100,000 people in the region.
Addressing business safety precautions, the Governor said that social distancing, continued testing, and ongoing monitoring protocols will be standard, and businesses must be able to adapt and meet all federal and state guidelines before reopening.
COVID-19 Billing Guidance for OMH-Licensed Clinic Programs
Today, the New York State Office of Mental Health (OMH) released new COVID-19 billing guidance (available here) for clinic programs participating in Medicaid. Effective March 7th and for the duration of the emergency, OMH is relaxing current time requirements for mental health clinics. Minimum service times have been eliminated or reduced to be consistent with the American Medical Association time standards. A full list of the minimum time reductions/rounding allowances by service is available in the guidance document.
The guidance document also addresses Medicare/Medicaid crossover claims for dual eligible individuals. For services provided by a Medicare-enrolled practitioner, the guidance indicates that claims must be submitted to Medicare first before crossing over to Medicaid, using the required Medicare procedure code(s) and adhering to Medicare rules regarding telehealth or telephonic service provision. Clinics should not change the procedure code before crossing over to Medicaid or submit claims directly to Medicaid. When the Medicare-required telephonic codes are crossed to Medicaid, providers will be paid APG rates that are weighted based on the client diagnosis code (in the same way the office evaluation and management codes are paid). These presumably refer to the recently approved CPT codes 99441-99443 (medical practitioners) and 98966-98968 (behavioral health and therapists). However, Medicaid managed care plans may not cover these procedure codes or may not cover them at the same rate.
As per existing OMH clinic guidance, providers may bypass billing Medicare (previously known as “zero-fill”) when the service has been provided by a practitioner not recognized by Medicare (e.g., LMSW, LCAT, etc.). The claims for these practitioner types may be submitted to Medicaid directly using the original clinic APG procedure codes with the appropriate telehealth modifiers. Providers must maintain documentation on a yearly basis to prove that the service was not covered.
Questions regarding this guidance may be submitted to clinicrestructuring@omh.ny.gov.
Federal Update
HHS Provides State-by-State Breakdown of Initial $30 Billion in CARES Act Provider Relief Funding
Today, the Department of Health and Human Services (HHS) released a state-by-state breakdown of the total number of providers paid, and the amount of funding distributed, by the initial $30 billion made available through the CARES Act’s Public Health and Social Services Emergency Fund. The amounts are proportional to the amount of Medicare fee-for-service billing in 2019 from that state. In New York 26,282 providers received a total of approximately $1.86 billion. The breakdown is available here.