Can agencies be reimbursed for completing the LPHA Recommendation for CORE Services?
If the LPHA is a member of the CORE Services staff, time spent with the member (in-person or via approved telehealth) for the purposes of completing an LPHA recommendation may be billed under the service specific rate codes.
If the LPHA recommendation for Empowerment Services – Peer Support is completed by a member of the CORE staff, the time spent by the LPHA with the individual for the purposes of making an initial recommendation may be billed at the service-specific rate code, even if the LPHA is not otherwise qualified to deliver the service. For example, if an LPHA meets with an individual face-to-face to determine medical necessity for Empowerment Services – Peer Support, that time would be billable in 15- minute increments using rate code 7794, even if the LPHA is not also a certified peer.
Can we bill for communication w/ outside providers related to CORE services?
The CORE provider can bill for synchronous (real time, two-way) communication with outside providers as a collateral if it is for the benefit of the individual (i.e., advances their service plan or goal). See the Operations Manual for specific documentation requirements and information on consent. Synchronous communication with collaterals may be provided in person or via telehealth modalities. Emails, text messages, and instant messages with collaterals are not Medicaid reimbursable activities. The minimum service duration (15 min. per unit) applies to collateral contacts.
Can you provide a telehealth and in-person CORE Service for the same person on the same day and be able to bill for both services appropriately?
Yes, Providers serving an enrollee may submit one claim per day for each rate code/procedure code/modifier combination. In accordance with the CORE Services Operations Manual, and if clinically indicated, providers may submit claims for an in-person visit and telehealth visit for the same rate code in the same day.
Will rate codes stay the same or change for services transitioning from Adult BH HCBS to CORE?
Rates and rate code combinations will remain the same for CPST, FST, and Peer Support. Some PSR rate code combinations, rates, and other billing-related information will change as a result of the transition to CORE, including the addition of two new PSR rate codes and the discontinuation of the PSR per diem rate code. There will be two new provider travel supplement rate codes for CORE.