State-Sponsored Programs

Member Benefits & Programs

• What Does Medicaid Managed Care Cover?
• Sample Benefit Summaries
• Prepaid Benefit Package Definitions of Covered and Non-Covered Services
• Renewing Coverage for Essential Plan, Medicaid, HARP, and CHPlus
• Prenatal Program for Medicaid

Pharmacy

• Medicaid Pharmacy Benefit Transition
• Statewide Medication Assisted Treatment (MAT) formulary for opioid dependence agents and opioid antagonists
• Pharmacy Benefits for Medicaid
• Vaccines for Children (VFC)

Children's Health

• Expanded Services for Medicaid Child/Youth in Voluntary Foster Care Agencies
• Changes to Children’s Home and Community Based Services (HCBS) – Telehealth Respite Services
• Provider Notice: Medicaid Managed Care for Foster Care Members
• Medicaid Applied Behavior Analysis Benefit
• Preauthorization Required for Medicaid Children’s Home and Community Based Services
• 29-I VFCA Health Facility Providers
• 29-I VFCA Health Facility Services for Children/Youth
• Foster Care AND 29-I Transmittal Form
• 29-I Health Facility Billing Guidance
• 29-I Health Facility Billing Tool
• Reference Guide to Early Screenings and Follow-Up for Pediatric Health Care Providers
• Child Health Plus (CHPlus) Member ID Cards
• Medicaid State Plan and Demonstration Benefits for Children
• Special Services for Children
• Health Homes Serving Children
• Children’s Home and Community Based Services Provider Manual
• Children’s Health and Behavioral Health Services Billing and Coding Manual
• Appointment Availability Standards by Service Type for Medicaid Children’s Health and Behavioral Health Benefits
• Vaccines for Children (VFC)

Behavioral Health

• Project TEACH Maternal Mental Health Services
  
• Gambling Disorder Treatment, Provided by Office of Addiction Services and Supports (OASAS) Certified Programs
• Medicaid Applied Behavior Analysis Benefit
• Adult Behavioral Health Home and Community Based Services Manual
• Medicaid State Plan and Demonstration Benefits for Children
• Special Services for Children
• Health Homes Serving Children
• Children’s Home and Community Based Services Provider Manual
• Children’s Health and Behavioral Health Services Billing and Coding Manual
• Appointment Availability Standards by Service Type for Medicaid Children’s Health and Behavioral Health Benefits

Health and Recovery Plan (HARP)

• Helping HARP Members Get the Care They Need
• Adult Behavioral Health Home and Community Based Services Manual
• Behavioral Health Community Oriented Recovery and Empowerment (CORE) Services

Health Home and Home and Community Based Services (HCBS)

• Changes to Children’s Home and Community Based Services (HCBS) – Telehealth Respite Services
• Medicaid Health Home Program
• Health Home Billing Guide
• Health Homes Serving Children
• Children’s Home and Community Based Services Provider Manual
• Adult Behavorial Health Home and Community Based Services Manual
• Preauthorization Required for Medicaid Children’s Home and Community Based Services

Provider Certification and Training Requirements

• 29-I VFCA Health Facility Providers
• Cultural Competency Training Certification
• Disclosure Certification Form
• The Guide to Providing Effective Communication and Language Assistance Services
  

Provider Education Resources and Incentive Programs

• Medical Policies
• Clinical Practice Guidelines 
• EmblemHealth Learning Online
• New York State Medicaid Provider Training
• Office of the Medicaid Inspector General Compliance Library
• CMS Medicaid Program Integrity Education
• Cultural Competency Continuing Education and Resources
• New York Medicaid Statewide Patient-Centered Medical Home Incentive Program
• Managed Care Technical Assistance Center
• Project TEACH Maternal Mental Health Services

Provider Contract Provisions and Compliance Requirements

• New York State Standard Clauses - April 2017
• Special Provisions Related to Medicaid, CHIP and HARP Members
• Medicaid Managed Care Model Contract
• New York State-Sponsored Programs: Medicaid/HARP/Child Health Plus - Provider Compliance Requirements

News & Policy Updates 2014 - 2022

2022

• Billing Clarification for Practitioners Dispensing Medications
• eMedNY Provider Enrollment Portal Offers New Function
• Removal of Primary Care Provider Referrals for Specialty Care
• Expansion of Remote Patient Monitoring for Maternal Care
• Expansion of Child Health Plus (CHPlus) Covered Health Services for 2023
• Medicaid Perinatal Care Standards
• Reminder: Sign Up for eMedNY Training Webinars
• Orthopoxvirus/Monkeypox virus (MPV) Vaccine Administration, Reporting, and Testing
• Opioid Use Disorder Treatment Expanded to More Practitioners
• Medicaid Enrollment Requirements and Compliance Deadlines for Managed Care Providers
• Annual Home Care Worker Wage Parity Compliance Requirements Update
• Annual Home Care Worker Wage Parity Compliance Requirements Beginning June 2022
• Regulatory Changes Impacting Medicaid Personal Care Services (PCS)
• New York State COVID-19 Guidance for Medicaid Providers
• Reminder: Billing Guidance for Reporting Alternate Level of Care

2021

• Medicaid Expands Coverage for Asthma and Diabetes Self-Management Training and Smoking Cessation Counseling
  
• Removal of Service Limits on Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)
• Medicaid Expands Coverage of Fluoride Varnish Application for Dental Providers
• Medicaid Expands Coverage for Colorectal Cancer Screening
• Medicaid Hospital Inpatient Billing Discharge Status Codes
• Medicaid Expansion of Non-Invasive Prenatal Trisomy Screening
• Medicaid Definitive Drug Testing

2020

• No Referrals for SOMOS-Managed Members
• October 25-31 is HIV PrEP Aware Week for Medicaid/HARP 
• Medicaid Expands Provider Types for Fluoride Varnish Application in a Primary Care Setting
• Medicaid Dental Coverage for D1354 – Interim Caries Arresting Medicament (cavity treatment)
• Medicaid Smoking Cessation Counseling (SCC) Benefit – Starting Nov. 1, 2020
• God's Love We Deliver (GLWD) Medicaid/HARP Meal Intervention Program
• Medicaid National Diabetes Prevention Program (NDPP)

2014-2019

• Infertility Coverage Expansion for HIP Medicaid and Commercial Members
• Restricted Breast Cancer Surgery Facilities for Medicaid Recipients
• Paper Claims and Patient Consent Forms Required for Hysterectomy and Sterilization Procedures for Medicaid Patients
• New York State Medicaid Expansion of Coverage of Group A Streptococcus Testing for Practitioners
• MRT Compliance C-Section/Early Delivery Billing Update