(May 14, 2024) At its monthly Managed Care Policy and Planning meeting, the Department of Health (DOH) announced its transition of Fiscal Intermediary (FI) administrative payments to a non-risk distribution methodology . This move will be effective Ju ly 1 st .
Per Centers for Medicare and Medicaid Services (CMS) feedback, this will be done consistent with prior non-risk payment arrangements such as Home and Community-Based Services (HCBS) distributions. The State will move payment for FI administrative costs out of Managed Care Organization (MCO) capitation rates and into a directed payment that MCOs w ill then pass through to FIs in full. Funding will be removed from plan capitation and paid on a managed fee-for-service (FFS) basis with F Is billing plans, plans billing the tiered FFS schedule through newly established rate codes, and then passing the exact amount back to the FI.
The State added that a dditional details will follow as information becomes available.
The FFS rates will remain in a tiered format here.
M any questions are being raised by both the provider and plan communities regarding the time frame for implementation , billing codes and modifiers , timing of payments and billing , contract amendments , and potential member disrupt ion. LeadingAge NY will be assembling questions and concerns for the Department and requesting a delay in its implementation . Please reach out to Darius Kirstein ( dkirstein@leadingageny.org) and Karen Lipson ( klipson@leadingageny.org ) with questions and feedback for the Department.
Contact: Meg Everett, meverett@leadingageny.org , 518-867-8871