NHTD/TBI Program Notifies Providers of Upcoming System/Billing Changes

(March 18, 2025) On March 13, 2025, the Department of Health (DOH) issued a letter to all Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver providers advising of a future system/billing change that will affect NHTD and TBI service providers. The letter is available here, and a corresponding crosswalk document is here.

This update is necessary to align with the Centers for Medicare and Medicaid Services’ (CMS) waiver billing requirements which stipulate that claims must be billed to the locator based on the county in which services were provided; currently, claims are billed to the locator based on the participant’s county of fiscal responsibility. This change will also standardize billing locator codes/counties for all NHTD and TBI Waiver providers statewide and change NHTD Home and Community Support Services (HCSS) provider billing from one rate code for all HCSS regions to one rate code for each HCSS region – five in total, to align with TBI HCSS billing.

Providers will not yet be able to bill to these new county locator codes. The tentative effective date is July 1, 2025. Once all provider rate codes have been successfully transitioned to the new county locator codes in eMedNY, DOH will send out new billing guidance and instructions as well as schedule a webinar. Please see the letter and crosswalk document for additional instructions and details about the transition.

More information will be forthcoming in the next couple of months.

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