The New York State (NYS) Office of Mental Health (OMH) is launching a redesign of the Personalized Recovery Oriented Services (PROS) program, effective April 1, 2025.
View postACEs screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.
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View postProviders will no longer need to submit prior authorization requests to Evicore for select codes.
View postLicensed Home Care Service Agencies are required to obtain and document a physician order before providing personal care services and private duty nursing to Senior Health Partner, CompleteCare, and Medicaid Members.
View postAscenia/Bayer (Contour and Contour Next) products
View postStarting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services.
View postEyeMed manages Healthfirst’s prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, and claims payment for routine vision and medical optometry services.
View postAs part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Child Health Plus members under 21 years of age.
View postProviders can access Healthfirst tools through Availity Essentials, our new secure provider portal platform.
View postStarting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.
View postStarting January 1, 2025, Healthfirst is creating new service codes to accurately account for Linked and Mutual Visits provided to Medicaid, Personal Wellness Plans (HARP), Senior Health Partner (SHP) and CompleteCare (CC) members.
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