The Situation Report | November 27, 2023
The U.S. Centers for Medicare and Medicaid Services (CMS) has approved an amendment to the Appendix K for the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waivers that established new rates to supplement the rates for NHTD and TBI Structured Day Program (SDP) services provided face-to-face.
A rate differential of $10.00 per hour was added to new rate codes (NHTD – 9749; TBI – 9885) effective April 1, 2021. The enhanced $10.00 rate was effective April 1, 2021 through November 11, 2023. Effective immediately the two new rate codes (NHTD – 9749; TBI – 9885) will be zeroed out on all active MMIS Provider ID’s due to the expiration of the Public Health Emergency (PHE) and Appendix K authority.
The system will automatically do a negative retro take back on any claims submitted with a service date after November 11, 2023 using rate code 9749 or 9885. If one of the new rate codes were billed after November 11, 2023 you may re-bill using one of the original two rate codes.
Any claims with a date of service on or after November 12, 2023 will need to resume billing under the original two rate codes (NHTD – 9777; TBI – 9870)
Records detailing face-to-face service provision between April 1, 2021 through November 11, 2023 must be available upon audit.
For specific billing questions contact eMedNY/GDIT directly at: 1-800-343-9000.
Rates will be updated here:
NHTD: approved_rates.pdf (ny.gov)
TBI: tbi_app_rates.pdf (ny.gov)
Any questions may be also submitted to: nhtdwaiver@health.ny.gov or tbi@health.ny.gov.