On March 10, 2023, the Department of Health (DOH) issued a Dear Administrator Letter (DAL) to Certified Home Health Agencies (CHHAs) regarding modifications to the New York State Medicaid Grouper for CHHAs due to changes to the federal Outcome and Assessment Information Set-E (OASIS-E) tool.

Beginning Jan. 1, 2023, the federal OASIS-E tool that collects data for skilled Medicare and Medicaid patients aged 18 years and older was updated by the Centers for Medicare and Medicaid Services (CMS), which caused a disconnect between many of the claims billings systems and the current New York State Medicaid Episodic Payment System (EPS) Grouper scoring. With OASIS-E becoming effective Jan. 1, 2023, certain codes no longer exist and have been replaced with new codes. These new codes and two existing codes have been removed from the Recertification (Recert) and Other Follow-Up forms, but they do exist on the Start of Care (SOC) and Resumption of Care (ROC) forms. As a result, the Medicaid Grouper is no longer aligned to accurately calculate the patient’s clinical score, which is used to determine the proper rate to bill.

In order to facilitate billing, please refer to the instructions in the DAL. Please note that in light of the time required by providers and billing agents to update their systems and conduct necessary testing, the 90-day timely filing deadline has been waived through April 2023 date of service claims. Providers using this waiver should complete all claiming by May 31, 2023 (one month after the conclusion of the waiver) using delay reason code 3.

Billing codes are attached to the DAL for providers. Please carefully review the DAL and its attachments.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871