BEHAVIORAL HEALTH SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4
4 min read

SUPPORTING MENTAL WELL-BEING THROUGH THERAPEUTIC INTERVENTIONS AND HOLISTIC CARE

Behavioral Health Services in New York support individuals with mental health conditions, substance use disorders, or behavioral challenges by providing counseling, therapy, and support services. These services are designed to promote mental well-being, enhance coping skills, and support recovery. Behavioral Health Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

Role: Administers Medicaid waiver funding for Behavioral Health Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: New York State Office of Mental Health (OMH)

Role: Ensures compliance for behavioral health programs serving individuals with mental and behavioral health needs.

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for behavioral health services targeting individuals with developmental disabilities.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Behavioral Health Services meet quality, safety, and person-centered care standards.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral Health Services include therapeutic interventions, mental health counseling, and behavioral support aimed at promoting emotional well-being and managing mental health challenges.

Approved providers may deliver:

Individual Counseling: One-on-one therapy sessions addressing mental health challenges.
Group Therapy: Facilitated group sessions for peer support and skill-building.
Substance Use Counseling: Support for individuals dealing with addiction and recovery.
Crisis Intervention: Immediate support during mental health emergencies.
Case Management: Coordinating care among healthcare providers and community resources.
Behavioral Interventions: Implementing strategies to address disruptive or harmful behaviors.
Psychoeducation: Educating individuals and families about mental health conditions and coping strategies.
Medication Management: Monitoring the effectiveness and side effects of psychiatric medications.
Social Skills Training: Building interpersonal skills for community and social interactions.
Trauma-Informed Care: Providing therapeutic approaches sensitive to past trauma.
Documentation: Maintaining accurate records of assessments, therapy sessions, and treatment outcomes.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Behavioral Health provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for therapy practices, crisis intervention, and mental health support.
Ensure staff complete required background checks, health screenings, and licensure verifications.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Behavioral Health Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, behavioral health policies, and staff licensure documentation.

Program Readiness Review:

NYSDOH, OMH, and OPWDD evaluate provider readiness, including clinical protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Behavioral Health Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Behavioral Health Policy & Procedure Manual, including:
- Counseling, therapy, and crisis intervention protocols
- Safety protocols and emergency response guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for therapy tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Quality assurance and compliance monitoring
- Client consent, confidentiality, and safety practices

6. STAFFING REQUIREMENTS

Role: Behavioral Health Program Director

Requirements: Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or Licensed Psychologist; Master’s or Doctorate in psychology, social work, or counseling.

Role: Therapists (LCSW, LMHC, Psychologists)

Requirements: State licensure; experience in individual, group, or family therapy.

Role: Substance Use Counselors

Requirements: Certified Alcohol and Substance Abuse Counselor (CASAC) or equivalent; experience in addiction recovery support.

Role: Behavioral Support Specialists

Requirements: Bachelor’s or Master’s in psychology, social work, or human services; experience with behavioral interventions.

All staff must complete:

Training in trauma-informed care, therapeutic interventions, and mental health support
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety, crisis management, and client interaction training
Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Behavioral Health Services are available under the following New York Medicaid Waivers:

OPWDD Comprehensive Waiver
Home and Community-Based Services (HCBS) Waiver
Nursing Home Transition and Diversion (NHTD) Waiver
Traumatic Brain Injury (TBI) Waiver
Children’s Waiver

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: New York Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Behavioral Health Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

New York State Department of Health (NYSDOH)

Website: https://www.health.ny.gov/

Office for People With Developmental Disabilities (OPWDD)

Website: https://opwdd.ny.gov/

New York State Office of Mental Health (OMH)

Website: https://omh.ny.gov/

eMedNY Provider Enrollment Portal

Website: https://www.emedny.org/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW YORK BEHAVIORAL HEALTH SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Behavioral Health Services in New York, offering:

Scope of Work:

Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for therapy and mental health support
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and client outreach strategies
Quality assurance systems for therapeutic care and compliance monitoring
Collaboration with healthcare providers, mental health agencies, and community organizations