New York State’s Chapter 57 of the Laws of 2024, effective Jan. 1, 2025, marks a significant shift in how commercial insurers must reimburse in-network facilities providing outpatient mental health and substance use disorder services licensed by the Office of Mental Health (OMH) or certified by the Office of Addiction Services and Supports (OASAS). This mandate requires insurers to pay at least the Medicaid rate for covered services, aiming to ensure fair compensation for providers and improve access to critical behavioral health care. However, early indications suggest that some in-network providers for commercial plans are experiencing challenges being reimbursed at less than the Medicaid rate. Let’s understand the implications of Chapter 57, potential reasons for missed revenue, key compliance checkpoints for providers, and actionable steps to address discrepancies.
Understanding Chapter 57: A Game-Changer for Behavioral Health Reimbursement
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