Waiving Member Cost-Shares for Outpatient Behavioral Health Services
6/10/2020
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Posted by Provider Relations
The New York State Department of Financial Services (DFS) posted a coronavirus (COVID-19) regulation update regarding mental health services coverage for Medicaid Managed Care Plans and Essential Plans, effective 5/2/2020. The DFS regulation states that member cost-shares* should be waived for in-network, outpatient behavioral health (mental health and substance use) services for essential workers.
In response to the DFS requirement regarding essential worker cost-share waiving, Fidelis Care has committed to extending this same provision to all members, essential or non-essential workers, for the specified 90-day timeframe, 5/2/2020 – 8/2/2020. Fidelis Care will be waiving all cost-shares (copays, coinsurance, and deductibles) for all members, , for in-network, outpatient behavioral health services (mental health and substance use) for dates of service between 5/2/2020 – 8/2/2020 inclusive.
If an in-network provider has previously collected a cost-share amount from a member (deductible, copayment, or coinsurance) for an outpatient, behavioral health service as described above, the provider is asked to reimburse the member for the cost-share collected. Fidelis Care will be adjusting the provider claims that have processed with a member cost-share applied so that providers will be reimbursed for the amounts deducted.
Refer to the DFS website for further details via the links below:
https://www.dfs.ny.gov/industry_guidance/coronavirus/coverage_for_mental_health_services_for_essential_workers_faqs
https://www.dfs.ny.gov/industry_guidance/circular_letters/cl2020_10
*waiving of cost-shares does not extend to prescription drugs