The New York State Department of Health (NYSDOH) has issued two public notices of intent to amend the State Medicaid Plan: 1) to change how dental implants are reimbursed when performed at Federally Qualified Health Centers [FQHCs]; and 2) to change how tribal facilities will be reimbursed, including for up to a total of three [3] services per member per day for any combination of medical, behavioral health, dental, and ambulatory visits delivered face-to-face [either in person or via telehealth/ telemedicine] as part of an eligible threshold visit.  The complete public notices published in the New York State Register today are below.

PUBLIC NOTICE

Department of Health

Pursuant to 42 CFR Section 447.205, the Department of Health hereby gives public notice of the following:

The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to comply with NYS Social Services Law § 365-a (1), (2).

The following changes are proposed: Non-Institutional Services

Effective on or after October 1st, 2024, payments to Federally Qualified Health Centers (FQHCs) for medically necessary dental implants and implant-supported services will be made using an alternative payment methodology (APM) via the NYS Medicaid dental fee schedule in lieu of the prospective payment system (PPS) base rate.  This method will reimburse FQHCs an amount greater than the PPS rate, to acknowledge the higher costs associated with resources, materials, treatment time, and the scope of skilled services needed to perform these procedures.  The estimated net aggregate increase in gross Medicaid expenditures attributable to this initiative for state fiscal year 2024-2025 is $10,637.

The public is invited to review and comment on this proposed State Plan Amendment, a copy of which will be available for public review on the Department’s website at http://www.health.ny.gov/regulations/state_plans/status.  Individuals without Internet access may view the State Plan Amendments at any local (county) social services district.

For the New York City district, copies will be available at the following places:

New York County, 250 Church Street New York, New York 10018

Queens County, Queens Center 3220 Northern Boulevard Long Island City, New York 11101

Kings County, Fulton Center 114 Willoughby Street Brooklyn, New York 11201

Bronx County, Tremont Center 1916 Monterey Avenue Bronx, New York 10457

Richmond County, Richmond Center 95 Central Avenue, St. George Staten Island, New York 10301

For further information and to review and comment, please contact: Department of Health, Division of Finance and Rate Setting, 99 Washington Ave., One Commerce Plaza, Suite 1432, Albany, NY 12210, spa-inquiries@health.ny.gov.

PUBLIC NOTICE

Department of Health

Pursuant to 42 CFR Section 447.205, the Department of Health hereby gives public notice of the following: The Department of Health proposes to amend the Title XIX (Medicaid) State Plan for non-institutional services to outpatient clinics operated by a tribe or tribal organization and funded by the Indian Self-Determination Act (Public Law 93-638).

The following changes are proposed: Non-Institutional Services

Effective on or after October 1, 2024, the Department of Health will amend the New York Medicaid State Plan for Tribal 638 outpatient facilities to clarify that outpatient services provided by or through facilities of the Indian Health Services (IHS) which includes, at the option of the tribe, facilities operated by a tribe or tribal organization and funded by Title I or V of the Indian Self Determination and Education Assistance Act, also known as Tribal 638 facilities are paid at the most current applicable rates published in the Federal Register or Federal Register Notices by IHS. There is no estimated change to gross Medicaid expenditures as a result of this proposed amendment.

Effective on or after October 1, 2024, New York State will reimburse Indian Health Service (IHS) /Tribal 638 facilities enrolled in New York State (NYS) Medicaid as a Tribal Federally Qualified Health Center (TFQHC) an alternative payment methodology (APM), which is equal to the federal all-inclusive rate (AIR) published annually in the Federal Register.  TFQHCs will be reimbursed the full APM/ AIR for eligible threshold visits rendered by qualified healthcare practitioners who are recognized/approved under the NYS Medicaid State Plan.  This change will allow TFQHC’s to be reimbursed the full APM/AIR for services provided to American Indians/Alaska Natives (AI’s/AN’s) either outside the four walls of the IHS/Tribal facility or for services provided to AI’s/AN’s “Through” the TFQHC under a written care coordination agreement.  IHS/Tribal 638 facilities, including TFQHCs, will be able to be reimbursed for up to a total of three (3) services per member per day for any combination of medical, behavioral health, dental, and ambulatory visits delivered face-to-face (either in person or via telehealth/ telemedicine) as part of an eligible threshold visit.  Eligible threshold visits are limited to Medicaid-covered services rendered by qualified healthcare practitioners who are recognized/approved under the NYS Medicaid State Plan.  Tribal FQHC’s may provide an array of distinct, non-related services to a member during a single encounter.  This change would allow IHS/Tribal facilities the ability to be reimbursed the full APM/AIR for up to three (3) eligible threshold visits rendered face-to-face (either in person or via telehealth/telemedicine) when distinct, non-related services are provided to a member during a member encounter or when delivered as a part of a care coordination agreement per member per day.  The estimated net aggregate increase in gross Medicaid expenditures as a result of this proposed amendment for state fiscal year 2024- 2025 is $2.6 million.

The public is invited to review and comment on this proposed State Plan Amendment, a copy of which will be available for public review on the Department’s website at  http://www.health.ny.gov/regulations/state_plans/status.  Individuals without Internet access may view the State Plan Amendments at any local (county) social services district.

For the New York City district, copies will be available at the following places:

New York County, 250 Church Street New York, New York 10018

Queens County, Queens Center 3220 Northern Boulevard Long Island City, New York 11101

Kings County, Fulton Center 114 Willoughby Street Brooklyn, New York 11201

Bronx County, Tremont Center 1916 Monterey Avenue Bronx, New York 10457

Richmond County, Richmond Center 95 Central Avenue, St. George Staten Island, New York 10301

For further information and to review and comment, please contact: Department of Health, Division of Finance and Rate Setting, 99 Washington Ave., One Commerce Plaza, Suite 1432, Albany, NY 12210, spa-inquiries@health.ny.gov.