jump to content
New York State Office of Alcoholism and Substance Abuse Services Link to New York State Office of Alcoholism and Substance Abuse Services Home Page

Home

Provider Readiness & Training

Provider Resources

Readiness Checklist for the Move to Managed Care

General Readiness Points to Consider:

  • Billing Software and/or Billing Vendor can submit clean claims to various plans.
  • Billing staff knows the managed care plans in the region and have current commercial contracts or contacts within the managed care behavioral and physical health divisions.
  • Clinical staff is aware of medical necessity criteria and utilization review expectations.
  • The program has identified how it will communicate to plans utilization review, contract issues and billing.
  • Clinical program staff have conducted a review on current service delivery with a focus toward marketability:
    • Are services provided medically necessary?
    • What outcomes does the program currently have? How is the program working to improve patient outcomes?
    • Does the program focus on efficient use of resources? There will be a shift in focus from volume driven payment in a fee-for-service environment to value driven payment.
    • How is the program preparing?
    • Do you offer unique services, serve a difficult or unique population?
    • Are you able to engage and retain patients?

New Comprehensive Medicaid Managed Care Readiness Self Assessment Tool

Programs are encouraged to utilize the Medicaid Managed Care Readiness Self-Assessment Tool. This is a voluntary tool to facilitate provider readiness for Medicaid Managed Care. Providers should not submit the Self-Assessment Tool results to OASAS, but may choose to submit results to Managed Care Technical Assistance Center (MCTAC) External Link to help inform future training sessions.

Home and Community Based Services (HCBS)

HCBS SERVICES WITHIN A HEALTH AND RECOVERY PLAN (HARP) External Link PDF Document

  • HARP eligible enrollees will have the ability to access an enhanced benefit that includes an array of HCBS services.
  • Please be advised that incorporation of HCBS services into HARP plan networks will not begin until all CMS approvals have been received.

HCBS Provider Manual PDF Document - Describes HCBS services as well as the basic requirements for any entity that is interested in providing HCBS behavioral health services within New York's public behavioral health system.

  • New York State is seeking stakeholder comments/questions on this HCBS Manual.
  • Please submit any comments/questions on the HCBS manual electronically by December 5, 2014 to PICM@oasas.ny.gov
  • Please be advised that the service definitions described in the manual are subject to change based on The Centers for Medicare and Medicaid Services (CMS) approval of the 1115 waiver.

HCBS Designation Required

  • In order to participate as an HCBS provider within a HARP's network, programs must be designated as eligible to provide HCBS services and contracted by the plan to deliver HCBS services to its enrollees.
  • All programs wishing to provide HCBS services must apply to be designated for each service they propose to offer and attest to meeting the staffing and service delivery criteria as outlined in the manual.
  • HCBS Provider Applications are now available.
  • More information about the HCBS designation process will be shared to our providers as it becomes available.