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Home Care News: New York State Department of Health Announces Delay in Transition to New Fiscal Intermediary Payment Methodology until August 1st (for now) The DOH has announced a postponement in the transition to a new non-risk distribution methodology for Fiscal Intermediary (FI) administrative payments. Originally scheduled to take effect on July 1, the new implementation date is now set for August 1, 2024. Key Highlights of the New Payment Methodology Effective August 1, 2024: Starting August 1, FIs will bill managed care plans using a three-tier per member per month (PMPM) schedule. Managed care plans will then bill the state using newly established rate codes and pass the exact amount back to the FI according to this rate structure: Tier 1: Rate Code 2443 1-159 Direct Care Hours Authorized Per Month Per Consumer FI PMPM Reimbursement Effective 4.1.2022: $146.45 Tier 2: Rate Code 2444 160-479 Direct Care Hours Authorized Per Month Per Consumer FI PMPM Reimbursement Effective 4.1.2022: $387.64 Tier 3: Rate Code 2445 480 and above Direct Care Hours Authorized Per Month Per Consumer FI PMPM Reimbursement Effective 4.1.2022: $1,046.36 Plans are instructed to bill eMedNY using the rate code corresponding to the number of service hours the MMC enrollee received in the billing month. Given the potential fluctuation in direct care hours, plans should submit claims for FI administrative costs no earlier than the first day of the following month. Plans should bill eMedNY via an electronic 837i form, using the first day of the billing month as the service date. Once the claim is adjudicated, plans will receive payment in the form of an EDI 820. #homecare #PMPM #wageparity
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2wThis is insane