Table 1. Benefits in Mainstream MCOs for all Medicaid Populations 21 and over SPA Change Submitted Separately from this 1115 Demonstration Amendment but for Current delivery Inclusion in This Currently in NYS 1115 Benefit System (Either Future MCO Services Current State Plan Demonstration Package MCO or FFS) Benefit Package Medically supervised Yes Rehabilitation option per Yes Managed care for Yes for MCO outpatient withdrawal 42 CFR 440.130 MCO enrollees; enrollees (OASAS services) FFS for nonMCO enrollees Outpatient clinic and Yes clinic option per 42 Move to rehabilitation Outpatient clinic and OTP is FFS for all FFS under clinic Yes for MCO — opioid treatment CFR 440.90 option per 42 CFR Medicaid enrollees option enrollees program (OTP) 440.130 services (OASAS services) Outpatient clinic Yes clinic option per 42 Temporary assistance to needy families Managed care for Yes for MCO — services (OMH CFR 440.90 (TANF) and safety net assistance TANF and SNA; FFS enrollees services) (SNA) only; for SSI and duals Comprehensive Yes outpatient hospital TANF and SNA only; FFS for all SSI Managed care for Yes for MCO — psychiatric service (42 CFR 440.20) Medicaid recipients TANF and SNA; FFS enrollees emergency program for SSI and duals Continuing day Yes clinic option per 42 No FFS only Yes for MCO — treatment CFR 440.90 enrollees Partial hospitalization Yes clinic option per 42 No FFS only Yes for MCO — CFR 440.90 enrollees PROS Yes rehabilitation option No FFS only Yes for MCO — per 42 CFR 440.130 enrollees ACT Yes rehabilitation option No FFS only Yes for MCO — per 42 CFR 440.130 enrollees Intensive case Yes TCM is being No FFS only Yes for MCO — management/ phased out; now using enrollees supportive case Health Home SPA management authority Health Home Care Yes Health Home per No Managed care for Yes for MCO — Coordination 1945 of Social Security Act MCO enrollees; enrollees
Table 1. Benefits in Mainstream MCOs for all Medicaid Populations 21 and over Services Current State Plan SPA Change Submitted Separately from this 1115 Demonstration Amendment but for Inclusion in This Demonstration Currently in NYS 1115 Benefit Package Current delivery System (Either MCO or FFS) Future MCO Benefit Package Medically supervised outpatient withdrawal (OASAS services) Yes Rehabilitation option per 42 CFR 440.130 Yes Managed care for MCO enrollees; FFS for nonMCO enrollees Yes for MCO enrollees Outpatient clinic and opioid treatment program (OTP) services (OASAS services) Yes — clinic option per 42 CFR 440.90 Move to rehabilitation option per 42 CFR 440.130 Outpatient clinic and OTP is FFS for all Medicaid enrollees FFS under clinic option Yes for MCO enrollees Outpatient clinic services (OMH services) Yes — clinic option per 42 CFR 440.90 Temporary assistance to needy families (TANF) and safety net assistance (SNA) only; Managed care for TANF and SNA; FFS for SSI and duals Yes for MCO enrollees Comprehensive psychiatric emergency program Yes — outpatient hospital service (42 CFR 440.20) TANF and SNA only; FFS for all SSI Medicaid recipients Managed care for TANF and SNA; FFS for SSI and duals Yes for MCO enrollees Continuing day treatment Yes — clinic option per 42 CFR 440.90 No FFS only Yes for MCO enrollees Partial hospitalization Yes — clinic option per 42 CFR 440.90 No FFS only Yes for MCO enrollees PROS Yes — rehabilitation option per 42 CFR 440.130 No FFS only Yes for MCO enrollees ACT Yes — rehabilitation option per 42 CFR 440.130 No FFS only Yes for MCO enrollees Intensive case management/ supportive case management Yes — TCM is being phased out; now using Health Home SPA authority No FFS only Yes for MCO enrollees Health Home Care Coordination Yes — Health Home per 1945 of Social Security Act No Managed care for MCO enrollees; Yes for MCO enrollees
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