which service may be reimbursed via a negotiated rate between the plan and the provider; and any applicable coding. When services are reimbursed via a negotiated rate, it is suggested that the prevailing Medicaid FFS rate service is used as an initial starting point for rate negotiations. Inpatient Providers: The Title 14 NYCRR OASAS Certified Part 816 detoxification / crisis services; and, Title 14 NYCRR OASAS Certified Part 818 Inpatient Rehabilitation Services are already incorporated into the benefit package. Part 820 treatment services are new for the Medicaid managed care benefit package Providers of Part 816 and Part 818 services should speak with the plan regarding the plan coding, contract, and reimbursement policies. Part 820 programs are reimbursed at the government rate. However, please note that at a minimum, plans must include providers as indicated below to meet minimum network requirements. Service OASAS Regulation / Certification Authority Negotiated or Government Rate Crisis Title 14 NYCRR Part 816 Medically Managed Negotiated Withdrawal Title 14 NYCRR Part 816 Medically Supervised Negotiated Inpatient Withdrawal (MSIW) W/Out Observation Days Title 14 NYCRR Part 816 Medically Supervised Negotiated Inpatient Withdrawal (MSIW) W/One Observation Days Title 14 NYCRR Part 816 Medically Supervised Negotiated Inpatient Withdrawal (MSIW) W/Two Observation Days Title 14 NYCRR Part 816 Medically Supervised Negotiated Outpatient Withdrawal (MSOW). Note: While this is not an inpatient service it is a crisis service that has been previously included in the benefit package and is not subject to government rates. Title 14 NYCRR Part 816 Medically Negotiated Supervised Inpatient Withdrawal (MSIW) Inpatient Title 14 NYCRR Part 818 Inpatient Negotiated Rehabilitation Rehabilitation Title 14 NYCRR Part 818 Inpatient Negotiated Rehabilitation - State Operated (ATC) Residential Title 14 NYCRR Part 820 Residential Programs Government Rate Treatment 24 months See rate table below
which service may be reimbursed via a negotiated rate between the plan and the provider; and any applicable coding. When services are reimbursed via a negotiated rate, it is suggested that the prevailing Medicaid FFS rate service is used as an initial starting point for rate negotiations. Inpatient Providers: The Title 14 NYCRR OASAS Certified Part 816 detoxification / crisis services; and, Title 14 NYCRR OASAS Certified Part 818 Inpatient Rehabilitation Services are already incorporated into the benefit package. Part 820 treatment services are new for the Medicaid managed care benefit package Providers of Part 816 and Part 818 services should speak with the plan regarding the plan coding, contract, and reimbursement policies. Part 820 programs are reimbursed at the government rate. However, please note that at a minimum, plans must include providers as indicated below to meet minimum network requirements. Service OASAS Regulation / Certification Authority Negotiated or Government Rate Crisis Title 14 NYCRR Part 816 Medically Managed Withdrawal Negotiated Title 14 NYCRR Part 816 Medically Supervised Inpatient Withdrawal (MSIW) W/Out Observation Days Negotiated Title 14 NYCRR Part 816 Medically Supervised Inpatient Withdrawal (MSIW) W/One Observation Days Negotiated Title 14 NYCRR Part 816 Medically Supervised Inpatient Withdrawal (MSIW) W/Two Observation Days Negotiated Title 14 NYCRR Part 816 Medically Supervised Outpatient Withdrawal (MSOW). Note: While this is not an inpatient service it is a crisis service that has been previously included in the benefit package and is not subject to government rates. Negotiated Title 14 NYCRR Part 816 Medically Supervised Inpatient Withdrawal (MSIW) Negotiated Inpatient Rehabilitation Title 14 NYCRR Part 818 Inpatient Rehabilitation Negotiated Title 14 NYCRR Part 818 Inpatient Rehabilitation - State Operated (ATC) Negotiated Residential Treatment Title 14 NYCRR Part 820 Residential Programs Government Rate 24 months See rate table below
harp-mainstream-billing-manual-9-1-15.docx