This is not legal advice, We cannot offer legal advice.
New York State RDN/CDNs are now ENROLLABLE PROVIDERS in New York State Medicaid Fee-for-Service (FFS)
Medicaid managed plans can deny services from Registered Dietitian Nutritionists (RDNs) who do not provide their Medicaid numbers. It is crucial to promptly share your Medicaid number with insurance plans upon receipt. Please note that it is your responsibility to communicate this information to the insurance plans, as they will not automatically receive it from NY Medicaid.
NYSAND has been collaborating with the New York State Department of Health for several years to create a pathway for NYSED CDN-credentialed RDNs to offer nutrition care services to Medicaid Fee-for-Service patients with documented medical necessity for MNT.
Lack of qualified nutrition care access has been a significant gap in care access for prevention, treatment, and management of complex medical and nutrition diagnoses. New York State RDN/CDNs have been challenged in many service settings by the lack of reimbursement for Medicaid patients. This coverage advance will allow RDN/CDNs to provide nutrition care services to New York children and adults that require them. NYSAND is grateful for the effort and support of our Department of Health colleagues that have worked with us to open the door to nutrition services for Medicaid patients.
Thank you to the NYSAND Medicaid Task Force Members: Ellie Wilson MS, RDN, CDN, Robert Lawrence Howard, LCDN, RD, MS, CDE , Susan Paredez, MS, RD, CDN, Lois Chait RDN, CDN, LDN for their commitment and dedication to making RDNs enrollable in NY Medicaid.
When is this effective? January 1, 2024
Who MUST enroll? All New York State RDN/CDNs that currently bill for nutrition services to NYS Managed Medicaid patients, and all RDN/CDN providers that see Medicaid fee for service patients for nutrition services in the outpatient setting.
Why is enrollment mandatory? It is federally mandated by the 21st Century Cures Act that all Managed Medicaid providers must also be enrolled as Medicaid providers in state plans. Enrollment is required immediately – NYS Medicaid FFS billing and third-party Managed Medicaid (MMC) insurers will require your Medicaid MMIS (Medicaid Management Information System ID) number on all Medicaid patient documents. If you do not bill insurance for any Medicaid participants, or plan to in the future then you do not need to enroll.
NOTICE regarding Managed Medicaid MNT Coverage – Medicaid Managed Plans in NY must cover MNT services:
https://www.health.ny.gov/health_care/medicaid/program/update/2023/docs/mu_no17_dec23.pdf
To reduce risk of reimbursement or coverage interruption, New York State RDN/CDN’s providing nutrition care services to Managed Medicaid participants are encouraged to reach out to third-party insurance account representatives to ensure their prior credentialed status is still valid, or, to advise the insurer they are applying for their MMIS#, and to update MMC insurers with their NYS MMIS# when they receive it. It is also recommended that NYS RDN/CDNs obtain guidance and credential with third-party insurances offering MMC insurance to NYS participants.
When do I have to enroll? As soon as possible. Enrollment will take 60-90 days so the sooner you enroll the better.
What are the enrollment steps? The enrollment forms are fillable PDFs that must be completed and then printed, signed, and notarized. All sections must be completed, or the enrollment documents will be rejected.
Provider Enrollment – information/steps/forms are here:
- https://www.emedny.org/info/ProviderEnrollment/
- https://www.emedny.org/info/ProviderEnrollment/enrollguide.aspx#web=step1&webtab=tabstep1
Form Tips: Please review before completing the forms. You should have located a Notary Public for quick access and form completion.
- RDN/CDNs should have their CDN# and NPI# ready when they access the forms.
- The provider zip code requires the four number suffix.
- The question regarding whether RDNs have a limited license: the response is No.
- NOTE: Signatures must be “wet”; notarized and manually signed in pen. No e-signatures are allowed. Most banks have free notaries.
- Additional forms to attach:
- https://www.emedny.org/info/ProviderEnrollment/ProviderMaintForms/701101_EFT_FORM_EFT_Enrollment_Form.pdf
- With voided check or bank letter
- https://www.emedny.org/info/ProviderEnrollment/ProviderMaintForms/490602_ETIN_CERTIFICATION_STATEMENT_FOR_NEW_ENROLLMENTS.pdf
- Proof of license (CDN and RDN)
- https://www.emedny.org/info/ProviderEnrollment/ProviderMaintForms/701101_EFT_FORM_EFT_Enrollment_Form.pdf
- We recommend mail tracking to ensure the documents have been received.
How will I know if my application was rejected?
Your paper application will be mailed back to you with errors noted, to be corrected and resubmitted.
How long will it take? NYS Medicaid is anticipating a substantial number of RDN applications. They estimate it will take approximately 60 – 90 days to obtain approval and the MMIS# assignment.
Can I still bill for the current NYS Managed Medicaid patients I have been working with?
It is our understanding insurers are legally obligated now to ensure Managed Medicaid providers are enrolled in Medicaid fee for service. Per member feedback, some insurers are allowing continued coverage/billing during the enrollment window, and some have notified providers they will not allow care until the MMIS# is obtained. Please contact the insurers your practice works with to ensure accurate information.
How can I track enrollment progress? eMedNY has a portal for tracking enrollment status here: https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/
What are the billing codes and rates?
Fee schedules and billing guidance can be found here: https://www.emedny.org/ProviderManuals/nutritionist/
How do I bill NY Medicaid?
https://www.emedny.org/ProviderManuals/AllProviders
How will I be notified of regulatory or other important information?
It is strongly recommended that Providers join the Medicaid Provider email list here mrtupdates@health.ny.gov and the https://www.emedny.org/Listserv/eMedNY_Email_Alert_System.aspx
Please use the Provider Handbook for additional information on policy guidelines, fee schedules, and billing guidelines. https://www.emedny.org/ProviderManuals/nutritionist/
Do you need to pay the application fee?
NYS RDNs are exempt from the application fee regardless of setting but must be enrolled in the correct category. I have already shared a walk-through draft with the “no fee” section highlighted for PP. I suggest the Reimbursement team decide if they want to distribute it or just keep this information for reference and inquiries.
The following link will take you to eMedNY’s Provider Enrollment page regarding Practitioner Groups. https://www.emedny.org/info/ProviderEnrollment/practGroups/ Unfortunately, the page has not been up updated to include RDNs, but you would enroll a group as Category of Service 0090. Please note that the yellow box with the category(s) of service shows at the bottom of the box that the Application Fee is NOT Required.
Should anyone get a notice from NYS DOH stating different information, they may reach out by email to: Mary Thatcher, Office of Health Insurance Programs mary.thatcher@health.ny.gov
Frequently Asked Questions:
Do all RDN/CDNs in our group practice have to enroll? Yes, anyone who will provide reimbursable nutrition care services to NYS Medicaid FFS or Medicaid Managed Care patients must enroll.
How can I track enrollment progress? eMedNY has a portal for tracking enrollment status here: https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/
Is there training for billing? Training can be found at the below links:
https://www.emedny.org/training
https://www.emedny.org/training/resources.aspx – EPACES billing system information
New York State Medicaid Terms and acronyms glossary: https://www.emedny.org/glossary.aspx
What if I have a problem or question? Please contact the support resources on the eMedNY website here: https://www.emedny.org/contacts/emedny.aspx. If you are unable to obtain information or require NYSAND’s assistance, please contact NYSAND@Caphill.com, and they will connect you with a Medicaid Task Force member.