When should children's providers begin using the CFTSS rate codes?
Providers of waiver services that crosswalk to OLP, CPST, or PSR must begin billing CFTSS codes for children currently enrolled in HCBS waiver programs on February 1, 2019. As of February 1, 2019, current (before Feb) HCBS Waiver services and their rate codes that are transitioning to CFTSS rate codes can no longer be billed. This includes the following services under the OMH HCBS or OCFS B2H Waivers: Skill Building; Crisis Avoidance, Management, and Training; Intensive In-Home Services; Immediate Crisis Response Service; and Crisis Response Services.
For children not enrolled in waivers, billing for CFTSS began on January 1, 2019.
For the time period of 10/1/19-1/1/19, should Medicaid Managed Care Plans (MMCPs) be hard-denying claims for Crisis Intervention (CI) and Youth Peer Support and Training (YPST) (the interim children's HCBS) service for non-waiver children? Are there any scenarios where this would be appropriate?
MMCPs should pend the claim and confirm the waiver status of the child as there may have been a delay in placing the K1 RRE code on the child’s case.