Medicaid Update – October 2025

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the October 2025 Medicaid Update. Please find the print-ready version of the issue available for download at: https://health.ny.gov/health_care/medicaid/program/update/2025/docs/mu_no10_oct25_pr.pdf.

You may also go straight to an article or topic that pertains to you by selecting from the current issue’s table of contents below.

All Providers

• Section 504 of the Rehabilitation Act of 1973 Final Rule (Cover)
• Attention New York State Medicaid Public Transit Automated Reimbursement Providers: MetroCard Phase-Out
• Reminder: Health Home Consent Forms

Policy and Billing

• Updated Implementation Date: Ambulatory Patient Group Weight Adjustment for Phosphate Binders
• Drugs Administered by Practitioners: New York State Medicaid Fee-for-Service Clinical Criteria Worksheets
• Casgevy™ (exagamglogene autotemcel) and Lyfgenia® (lovotibeglogene autotemcel): Centers for Medicare and Medicaid Services Cell and Gene Therapy Access Model

Pharmacy

• Health Resources and Services Administration 340B Rebate Model Pilot Program and Its Effect on NYRx

NYSHFA | NYSCAL CONTACTS:

Carl J. Pucci
Financial Consultant
518-462-4800 x36