Adult Day Health Programs – Revalidation

Carl Pucci and Shelley Sabo in Finance & Reimbursement

DOH has issued revalidation notices to hospital-based and freestanding nursing home-based Adult Day Health Care programs.  To date, many providers have not yet revalidated.  Below is the DOH notice, which contains the EMEDNY link for revalidation, as well as the appropriate DOH contact.

To:  Nursing Home and Hospital Associations:

The federal regulation 42 CFR 455.414 requires State Medicaid Programs to revalidate the enrollment of all providers at least every five years.

In early 2015 NY Medicaid contacted all providers of Hospital-based Adult Day Health Care Programs and Freestanding Nursing Home based Adult Day Health Care Programs.

Since many providers have NOT revalidated, DOH recently notified these providers by letter that their participation in NY Medicaid is terminated (see attachment “Reval term letter.pdf”)

Each provider # may have more than one Category of Service (COS), i.e. clinic, lab, inpatient, adult day health care.  Termination of a Provider ID will result in the inability to bill Medicaid for all COS listed under this Provider ID number.

Previously
these provider types were sent two written notices regarding revalidation:

  1. An Initial Revalidation letter; and
  2. A Second and Final Revalidation letter.


Providers were given over 6 months to revalidate their participation in NY Medicaid. 

Providers that received termination letters - and want to continue in NY Medicaid - must contact us immediately by writing our mail box at providerenrollment@health.ny.gov   AND sending in a revalidation application.

Your association can assist members by providing a link to our website www.emedny.org on your association page and training customer service staff on how to find information on Revalidation.  This will minimize confusion for your members if staff are able to direct them to the correct resources.  For more information on Revalidation, click here.

If association staff have any questions about revalidation, please contact Sue Zelezniak at Susan.Zelezniak@health.ny.gov. We appreciate your assistance with this important matter.

Susan Zelezniak
Assistant Director, Bureau of Provider Enrollment
Division of Health Plan Contracting and Oversight
New York State Department of Health

Office of Health Insurance Programs
Riverview Center Suite 600 E
Albany, NY 12237
518-474-8161
Susan.Zelezniak@health.ny.gov


NYSHFA CONTACT:

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36

Shelley Sabo
Executive Director, NYSCAL
518-462-4800 x17