Requires the universal coding and electronic payment of medical assistance claims for mental health or substance abuse disorder services

Title of bill

An act to amend the public health law, in relation to universal standards for the coding and electronic payment of medical assistance claims for mental health or substance abuse disorder services

Purpose

This bill would establish standardized billing codes for mental health and substance abuse disorder service providers to be utilized by Medicaid managed care organizations and other insurers. The bill further requires Medicaid managed care plans and other insurers to accept electronic payment of claims from such providers.

Summary of provisions

Section 1 of the bill adds new section 4403-h to the public health law to add the requirement for universal standard billing codes for mental health and substance abuse disorder services, to be used by insurers including but not limited to Medicaid managed care plans and insurers certified under article 44 of the public health law.

Further, a new section 4403-i to the public health law to authorize Medicaid managed care plans and other insurers certified under article 44 of the public health law to pay for substance abuse disorder or mental health services via electronic funds transfer.

Justification

The behavioral health industry is in the process of transitioning to Medicaid managed care. There are multiple challenges to ensuring that this transition happens smoothly for both providers and the patients who depend on their care. This bill would help mitigate some of these challenges by streamlining two administrative hurdles faced by providers.

Billing for Medicaid services has always been complex. Even under the current system, agencies can spend months submitting and resubmitting claims in a seemingly trial and error manner. Despite training from state agencies, both providers and managed care companies continue to be confused by billing requirements. As the state moves toward Medicaid managed care, providers are beginning to deal with multiple insurance plans all of which have their own system for processing claims and payments. These processing issues could be easily mitigated by streamlining codes and utilizing electronic billing, allowing providers to deal with similar processes with each insurer. These administrative hurdles are just one piece of multiple challenges to the transition to managed care, but getting out in front of this is important.

Legislative history

New bill.

Fiscal implications

None.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become a law; provided, however, that effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized and directed to be made and completed on or before such effective date.