MedicaidPrior AuthMedium impact
MNY Provider Newsletter Q4 2021 508 FINAL
Molina Healthcare·NY·Provider Newsletter
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
Molina Healthcare of New York acquired Affinity Health Plan effective 11/1/21, adding 305k+ Medicaid members. Starting 1/1/22, prior authorization will be required for CPT S5102 (adult day care services), and Beacon Health Options will no longer administer behavioral health benefits for downstate members.
Action Required
By January 1, 2022: Billing team must update system to require prior authorization for HCPCS code S5102 (adult day care services). Update encounter forms and remind providers that prior auth is mandatory for this service. For behavioral health services, verify member eligibility as Beacon Health Options will no longer administer benefits for downstate Affinity by Molina Healthcare members.