The New York City Department of Health and Mental Hygiene has partnered with Medicaid and Medicare Advantage Health Plans to compensate providers who proactively reach out to eligible patients in their panel who are not vaccinated. The member must receive counseling regarding the importance of vaccination and assist with arranging vaccination. Once all steps are completed, providers may bill for a Counseling Visit.
A counseling session may be provided by a licensed clinical provider (reimbursed $50 per counseling session) or a non-clinical designee (reimbursable at $25 per counseling session)
Who is eligible?
- New Yorkers residing in the 5 boroughs ages 12 and up on the NYCDOHMH member roster report.
- They must not have received the first dose at the time of the call.
Dates of service (timeframe):
- Sept 1st- Nov 30th, 2021
How will the funds be paid?
- For Innovator Plans:
- The Health Plan must provide the State with a claims report for all members eligible at the date of the counseling to be eligible to receive funding distribution.
- The Health Plan will then reimburse SOMOS based on the counseling codes submitted in the claim after the initiative has been finalized with the State.
- SOMOS will reimburse the provider based on the final reporting between the State and the Health Plan
For non-Innovator Health Plans, you will follow standard claims submission procedures for that Health Plan. We encourage you to contact your Health Plan representative for additional information.
Cultural Competency for Participating Providers
The New York State Department of Health (DOH) has approved cultural competence training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health. The training is online, free, and offers several provider-specific programs: Education – Think Cultural Health (hhs.gov).
All Managed Care Organizations have been tasked with notifying providers of this requirement for execution annually. Please take time to execute the training to ensure we continue to maintain compliance by clicking this link.
For more information, please contact your Practice Transformation Associate (PTA) or email ProviderRelations@somosipa.com