Who pays for the Other Licensed Practitioner (OLP) service for children in foster care?
OLP will be billed fee-for-service for children residing in a VFCA until the date those children are enrolled in managed care. If the child is already enrolled in managed care, OLP would be billed to the managed care plan (except for SSI children, who will receive CFTSS through managed care beginning 7/1/19.)
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.
If a Medicaid Managed Care Plan (MMCP) gets a claim from a provider who has been de-designated from children's HCBS, should the plan hard deny, or should they pay and notify the State?
Providers are required to be designated to provide Children’s HCBS. The MMCP can deny the claim if the provider was not designated at the time the service was provided.