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Managed Care Plans to Pass Through Administrative Payments to Fiscal Intermediaries

(May 14, 2024) At its monthly Managed Care Policy and Planning meeting, the Department of Health (DOH) announced its transition of Fiscal Intermediary (FI) administrative payments to a non-risk distribution methodology. This move will be effective July 1st.

Per Centers for Medicare and Medicaid Services (CMS) feedback, this will be done consistent with prior non-risk payment arrangements such as Home and Community-Based Services (HCBS) distributions. The State will move payment for FI administrative costs out of Managed Care Organization (MCO) capitation rates and into a directed payment that MCOs will then pass through to FIs in full. Funding will be removed from plan capitation and paid on a managed fee-for-service (FFS) basis with FIs billing plans, plans billing the tiered FFS schedule through newly established rate codes, and then passing the exact amount back to the FI.

The State added that additional details will follow as information becomes available.

The FFS rates will remain in a tiered format here.

Many questions are being raised by both the provider and plan communities regarding the time frame for implementation, billing codes and modifiers, timing of payments and billing, contract amendments, and potential member disruption. LeadingAge NY will be assembling questions and concerns for the Department and requesting a delay in its implementation. Please reach out to Darius Kirstein (dkirstein@leadingageny.org) and Karen Lipson (klipson@leadingageny.org) with questions and feedback for the Department.

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