Cultural Competency Training for Participating Providers

New York State Department of Health requires providers and their office staff who have regular and substantial contact with Healthfirst members certify annually the completion of Cultural Competency Training.

Delayed: Applied Behavioral Analysis (ABA) Benefit Carve Out

The October 1, 2021 Applied Behavioral Analysis (ABA) benefit carve out into Managed Medicaid has officially been postponed by New York State Department of Health. Providers should continue to submit claims for ABA services to Medicaid Fee-For-Service directly until further notice.

Four Behavioral Health Home and Community Based Services Transitioning to New Community Oriented Recovery and Empowerment Services

To improve access to rehabilitative care, New York State received federal approval to transition four Behavioral Health Home and Community Based Services (BH HCBS) to a new service array called Community Oriented Recovery and Empowerment (CORE) Services starting February 1, 2022.

Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

Behavioral Health Benefits Carve-In to Medicaid Advantage Plus (MAP)

Effective January 1, 2023, New York State (NYS) is carving additional Behavioral Health (BH) services into the Medicaid Advantage Plus (MAP) plan. Healthfirst's MAP plan is called CompleteCare.

Children’s Home and Community-Based Services (HCBS) Frequently Asked Questions

Children's Home and Community-Based Services (HCBS) are provided in the community and help children and youth be successful at home, in school, and in other environments. HCBS are personal and flexible and are meant to meet the physical health, behavioral health, and/or developmental needs of each child/youth.

BH | Prior Authorization Guidelines

Review this provider alert for BH prior authorization guidelines that apply to in-network providers only.

FAQ: Health and Recovery Plans (HARP) and Healthfirst’s Personal Wellness Plan (PWP)

See answers to frequently asked questions about Health and Recovery Plans and Healthfirst’s Personal Wellness Plan.

Behavioral Health Utilization Review Implementation

In response to a requirement by the New York State Office of Mental Health (OMH), Healthfirst has implemented a new, trigger-based approach to utilization review (UR) for certain acute mental health services (MH) for all of our health plans, except for Medicare Advantage plans.

Managed Care Technical Assistance Center of New York (MCTAC) Resources

Department of Health-Children and Family Treatment and Support Services