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MAP Behavioral Health Guidance Also Issued as MLTC Policy 22.03

Medicaid Advantage Plus (MAP) organizations and the Department of Health (DOH) have been preparing for the carve-in of Behavioral Health (BH) benefits into the MAP benefit package for over a year. Most plans have reached the readiness review stage in anticipation of a Jan. 1, 2023 implementation date. DOH has distributed and posted a number of resources, including a Readiness Review Tool, Billing Codes Manual, Rate Tables, and Coding Taxonomy, most recently adding Managed Long Term Care (MLTC) Policy 22.03, The Behavioral Health Benefits Carve In to MAP, that mirrors guidance first issued in May.

Policy 22.03 outlines network requirement standards that vary by enrollment, requiring plans to monitor the triggering thresholds, as well as appointment availability requirements that vary by service and are based on the level of urgency. MAP plans must meet BH staffing requirements and must submit organizational charts showing how BH staff will be integrated into existing organizational structures. Plans also need to explain how BH expertise is incorporated into the Interdisciplinary Care Team to demonstrate coordination with physical health and long term care management and meet specific BH staff requirements. The Policy document includes a table outlining staff training requirements.

Other responsibilities include the adoption, dissemination, and implementation of clinical practice guidelines and other evidence-based and promising practices as well as ways to identify high-risk enrollees. The Policy provides several appendices listing the combined Medicare Advantage and MAP benefit package for mental health, substance use disorder services, and services with joint Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) oversight, and ends with a series of links to archived educational trainings.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841