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Update on Uniform Billing Rate Codes

LeadingAge NY and other stakeholders continue to have ongoing discussions on uniform billing rate codes with the Department of Health (DOH). As we have previously reported, the codes will be used for home care, adult day health care services, and managed care plans. We had recommended developing a set of uniform billing rate codes in 2014 as part of the Home and Community Based Care workgroup. They were scheduled to go into effect in January 2016. In December 2016, DOH sent a Dear Administrator Letter (DAL) outlining the codes; however, after an informal complaint was made to the Centers for Medicare & Medicaid Services (CMS), the implementation of the codes was delayed.

LeadingAge NY is now working with DOH and other stakeholders to resolve revised codes and modifiers on personal care, consumer directed personal assistance, telehealth, and assessments. We are also resolving utilizing two-digit modifiers in lieu of three-digit modifiers. LeadingAge NY has made suggestions to DOH on codes, modifiers, and definitions.

DOH will draft another set of codes and modifiers for discussion at our next meeting. LeadingAge NY will keep members posted on any new developments.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841