Nov 11, 2025
New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
Early Intervention 4% Rate Modifier – Approval by CMS
Dear Colleague:
The Early Intervention Program (EIP) is pleased to announce
that the 4% rate modifier for Underserved and Rural areas of the State was
approved by the Centers for Medicare & Medicaid Services (CMS) on September
25, 2025. As part of the 2024-25 Enacted New York State Budget, the increase
will be retroactive to April 1, 2025.
The 4% increase will be applied to core in-person Early Intervention services that are provided to children who reside in rural and underserved areas of New York State that meet certain criteria. The following core services are eligible for the 4% rate modifier: evaluations, speech therapy, occupational therapy, physical therapy, and special instruction. Telehealth services are not eligible for the modifier.
Methodology
The criteria for zip code selection in rural and underserved
areas statewide are based upon three measures: 1) Poverty, 2) Rurality and 3)
Number of days waiting for core services. Zip codes were selected that met at
least one of the following criteria:
- poverty percentage greater than poverty threshold,
- rural percentage greater than rural threshold,
- number of days awaiting services greater than the county’s average number of days awaiting services.
The counties and providers do not have to take any
additional action in the data system, e.g. service authorizations or claim
code. The EI-HUB will apply the 4% rate modifier based on the service type and
child’s residential zip code.
Pursuant to the 4% Medicaid State Plan Amendment, the
eligible zip codes will be reviewed periodically, not less than annually.
The current list of eligible zip codes by county is attached to this notice.
The total fiscal impact of the 4% rate increase is expected
to be approximately $1M.
The list of eligible ZIP Codes is available here.
Implementation Timeline
The Department is working with the State Fiscal Agent,
Public Consulting Group (PCG), to implement the 4% rate modifier in the EI-HUB.
PCG estimates that the 4% rate modifier will begin to be processed
prospectively for new claims payable from municipal escrow submitted by the end
of December 2025.
For EI Medicaid claims, the Office of Health Insurance
Programs (OHIP) is updating eMedNY to be able to process the 4% rate modifier.
The Department estimates that OHIP can implement the rate modifier in eMedNY in
February 2026 for claims payable from Medicaid.
Additional information will be provided in the coming months
regarding processing of retroactive escrow payments of the 4% increase back to
April 1, 2025, as well as when Medicaid will begin processing the 4% in eMedNY.
If you have any questions regarding this notice, please contact the Bureau of Early Intervention at EIP.Fiscal@health.ny.gov or by phone at (518) 473-7016.