What happens with Voluntary Foster Care billing on July 1st 2021?
Voluntary Foster Care Agencies (VFCAs) are required to obtain and maintain Article 29-I licenses to bill for Core Limited Health-Related Services and Other Limited Health Related Services. VFCAs that have not obtained 29-I licensure are not authorized to provide these services. Article 29-I Facilities must bill Medicaid Managed Care Plan (MMCP) for those children enrolled in a MMCP.
Will initial enrollments be retrospective to the first day of the month a child/youth enters foster care? For example, if entry to foster care is 8/10, would the effective month of enrollment be 8/1? How would payment for services rendered by FFS providers between 8/1 and 8/10 be affected?
If a child/youth enters foster care on 8/10, and is not excluded from enrollment, the effective date of the Medicaid Managed Care (MMCP) enrollment is 8/1, as long as the LDSS opened the Medicaid case during the same month. Providers should wait till the enrollment process is completed prior to submitting claims to the MMCP.
Do 29-I Facilities follow the same billing rules for CFTSS and children’s HCBS as any other agency or are there differences when these are billed as part of Other Limited Health Related Services?
29-I Facilities must adhere to Children and Family Treatment and Support Services (CFTSS) and children's Home and Community Based Service (HCBS) billing requirements. The appropriate billing manual can be viewed here.
If the plan(s) has a subcontract with Beacon, or another plan for behavioral health, do we, the provider, bill Beacon or the MMCP for Article 29-I Core Services? Other Limited Health Related Services?
Core Limited Health Related Services are always billed directly to the Medicaid Managed Care Plan that you, the provider, are contracted with and not the delegate. For Other Limited Health Related Services, providers need to review their contract and talk with MMCP as this is different across plans.
For Article 29-I Core Limited Health Relates Services, what Diagnosis should I use?
Providers should use an applicable ICD-10 diagnosis. If the youth has more than one diagnosis, the provider only needs to include one on the claim. Providers may only use the ICD-10 code of R69 when the child/youth does not have a diagnosis identified at the time of the claim submission.
If a child, covered by a 29-I facility shows up for sick child visit but the doctor is also able to address something unrelated, are 2 bills submitted?
If the office visit covers both issues there would be one claim for the duration of the visit. This would include the additional procedure codes to describe what occurred in the encounter, define the complexity of the visit and support the time that it took. If the child goes into the office visit and there is another BILLABLE encounter that is distinctly different than the reason for the visit and outlined as permissible in the billing manual then there would be two claims.