561-Early Intervention 5% Rate Increase and Telehealth Decrease – Approval by CMS

 Early Intervention 5% Rate Increase and Telehealth Decrease – Approval by CMS

Dear Colleagues,

The Early Intervention Program is pleased to announce that Medicaid SPA #24-0041 has been approved. With this action, in-person rates are increased, and telehealth rates are reduced.

In person services

• There will be a 5% rate increase for in-person services retroactive to October 1, 2024.
• The 5% increase will be on top of the recent 4% rate modifier in rural and underserved areas.

 Telehealth services

·      The rate decrease will be 22% decrease in New York City, Nassau, Suffolk, Westchester, Rockland, Putnam, and Dutchess counties, and 10% decrease in the rest of the State.

·      The 5% in person rate increase does not apply to telehealth services.

·      This rate reduction was already applied to claims submitted on and after July 1, 2025. 

·      The rate reduction has not yet been applied to claims submitted prior to July 1, 2025

o   Implementation of Medicaid SPA # 24-0041 will apply the telehealth rate reduction to claims with dates of service on or after January 1, 2025, and submitted prior to July 1, 2025.

o   We will not implement the retroactive telehealth rate reduction until after the 5% in-person rate increase is fully implemented.  

 Implementation

• The Department expects implementation of the above actions to occur over the course of the next 90 days.
• Additional information will be provided with more specifics about the implementation timing for each action.
• If you have any questions regarding this notice, please contact the Bureau of Early Intervention at eipfiscal@health.ny.gov or by phone at (518) 473-7016.