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New York City Behavioral Health Transitions

Health and Recovery Plan (HARP) Enrollment Notices: What Providers Need to Know

Effective October 1, 2015, Medicaid Managed Care (MMC) plans will begin covering expanded Behavioral Health services for adults in New York City. Also effective October 1, 2015, Health and Recovery Plans (HARPs) will begin enrollment of eligible recipients with Serious Mental Illness (SMI) and Substance Use Disorders (SUD). HARP enrollment will be phased in, beginning with current MMC adult enrollees who are system identified as HARP eligible in New York City. 

During August 2015, MMC plans operating in New York City began sending announcement letters to all adult enrollees informing them of the changes to the Medicaid program. On August 13, 2015, New York State’s enrollment broker, New York Medicaid Choice, began sending enrollment notices on a daily basis to State-identified eligible recipients, and will continue through Fall, 2015. Eligible MMC enrollees will either be passively enrolled or given an option to enroll in a HARP, depending upon current plan enrollment.

Please see the September 2015 Medicaid Update article entitled “Health and Recovery Plan (HARP) Enrollment Notices: What Providers Need to Know” for additional details regarding the enrollment process and associated notices to MMC enrollees.

Billing for Behavioral Health Services for New York City SSI and SSI-Related Enrollees

Effective October 1, 2015 in New York City, the Medicaid Managed Care (MMC) benefit package is expanding to include certain Behavioral Health (mental health and alcohol and substance use disorder) programs and services and injectable medications (long-acting atypical antipsychotics and extended release naltrexone) for all enrollees age 21 and over. These services will no longer be covered under the Medicaid Fee-for-Service (FFS) program for SSI and SSI-Related enrollees, requiring these Behavioral Health provider claims to be billed to the enrollee’s Medicaid Managed Care plan. Commencing July 1, 2016, this expansion will apply to the Rest of the State.

System configurations are being made in order to support this transition but continued modifications are still in progress. Please see the September 2015 Medicaid Update article entitled “Billing for Behavioral Health Services for New York City SSI and SSI-Related Enrollees” for more details regarding the system changes and how they may affect your provider community.

Pharmacy Changes for New York City Behavioral Health Transition to Managed Care

Effective October 1, 2015, Medicaid Managed Care (MMC) plans serving New York City enrollees will begin covering injectable atypical (second generation) long acting antipsychotics for their SSI and SSI related enrollees. MMC plans serving New York City enrollees will also begin covering naltrexone extended release suspension (Vivitrol®). Additionally, policies that promote access to these medications and smoking cessation agents are being implemented. Please see the September 2015 Medicaid Update article entitled “Pharmacy Changes for New York City Behavioral Health Transition to Managed Care” for details regarding these changes

The above referenced articles can be found in the September 2015 edition of the Medicaid Update posted on the New York State Department of Health website.

Additional information regarding the expansion of behavioral health services in Medicaid Managed Care and the services available through Health and Recovery Plans is available in the July 2015 Special Edition Medicaid Update.

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Last Updated On: 3/17/2016