To align with the New York State Medicaid Pharmacy Program policies, Healthfirst will no longer reimburse any contrast agents used for radiological testing for members enrolled in Medicaid Managed Care (MMC) or Personal Wellness Plans (HARP).
View postStarting September 1, 2025, Healthfirst is introducing new prior authorization guidelines for select Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) services.
View postRequired Mandatory Annual Compliance Training
View postThe United States Department of Justice has issued new regulations titled the “Final Rule on Preventing Access to U.S. Sensitive Personal Data and United States Government-Related Data by Countries of Concern”, codified at 28 C.F.R. Part 202.
View postEffective September 1, 2025, Healthfirst will implement concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit.
View postEffective Jan 1, 2025, The Centers for Medicare & Medicaid Services (CMS) finalized several updates to the Medicare Diabetes Prevention Program (MDPP).
View postReimbursement Updates for eConsults
View postEffective Jan 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Physician Fee Schedule Final Rule with key updates impacting Preventive Services for Medicare members.
View postIn accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).
View postLearn more about prior authorization guidelines for select Remote Patient (RPM) and Remote Therapeutic Monitoring (RTM) services, effective September 1, 2025.
View postThe New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.
View postNew York State will resume standard annual recertification procedures for off-exchange Medicaid, Personal Wellness Plan (HARP), Life Improvement Plan (LIP), CompleteCare (CC), and Senior Health Partners (SHP) members.
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