Issue #26-06

The purpose of this Alert is to notify all SSHSP Medicaid Providers of changes to the cost reporting and time studies related to the pending approval of SPA 23-0072.

Cost Reporting:

• Tuition can no longer be a reported cost as of July 1, 2023 (FY24 Cost Report). The Centers for Medicare and Medicaid Services will no longer allow the prior allocation method using health-related tuition percentages. For more information, see companion letter with SPA 20-0059 approval.

• Local Education Agencies (LEAs) no longer need to report the denominator for the IEP Ratio. Going forward, the State Education Department Data Unit will determine the LEA-specific Medicaid Enrollment Ratios using Basic Education Data System day student enrollment reports and Medicaid enrollment data for the same point in time.

Time Study:

• Returning to the two-day advance notice of moment surveys as of August 2025.
• Implementing and operating a year-round, four-period time study, effective July 1, 2026.  More information is forthcoming. Fairbanks will be in contact with the LEAs.

Upon approval of SPA 23-0072, the program will publish official policy regarding coverage for psychological evaluations and counseling services provided to students without IEPs.  Policy will cover:

• Documentation: A non-IEP treatment plan (e.g. a statement of the goals and objectives of treatment to address the recipient’s problems, disabilities and needs, including an estimate of the duration of the recipient’s need for treatment, a description of the proposed treatment and prognosis), written referral, evaluation report, and notes.
• Provider Qualifications: Licensed/registered psychiatrist, licensed/registered psychologist, licensed clinical social worker (LCSW), or a licensed master social worker (LMSW) operating under the supervision of a psychiatrist, psychologist, or an LCSW.
• Procedure code modifier with existing interim fee-for-service (FFS) billing codes.
• Reimbursement rates for the new services will be consistent with the existing interim FFS rates.  

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov, or the NYS Education Department, Medicaid Unit at medined@nysed.gov.