Frequently Asked Questions

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For the CFTSS, OLP Crisis Triage, which has a 15 minute unit, what should be done if the call is less than 15 minutes? Can this be 5 minutes instead?

It is anticipated that Crisis calls usually take more than 15 minutes. Providers will not be able to bill for crisis triage call that are less than 15 minutes.

Source: July 2018 CFTSS Billing In-Person Training

In CFTSS, how do you bill for more than one OLP evaluation?

There is not a set limit in the billing manual. Providers should follow billing procedures as outlined in the billing manual.

Source: July 2018 CFTSS Billing In-Person Training

Why in CFTSS is only OLP Crisis Complex Care in 5 min units/max 20 minutes? Was it not agreed that all crisis OLP services would be kept consistent in terms of units and increments?

Crisis Complex Care (Follow Up to Crisis) is meant to be a brief follow up call post crisis services.

Source: July 2018 CFTSS Billing In-Person Training

In CFTSS, do you need a diagnosis to bill for OLP (Other Licensed Practitioner)?

You do not need a diagnosis to bill for OLP Evaluation. You should use R69 (or for United F99) in field 67 of the paper claim form. If you have seen the individual many times, it is likely a diagnosis would be determined and you would no longer be using R69.

Source: July 2018 CFTSS Billing In-Person Training

Is there a rate code for CFTSS OLP Complex Care off-site?

Complex Care is provided by telephone, so there is no differentiation needed for offsite vs. on site.

Source: CFTSS: OLP, PSR, CPST Billing and UM Office Hour 11.15.18

Will the SED rate codes be billed to Medicaid Managed Care, or will standard codes be used after the children's transition is complete?

As of 7/1/19, providers should bill Medicaid Managed Care using standard APG rate codes. 

Source: State February Roundtable 2019

As an Article 31, outpatient mental health clinic, for children that we have been providing clinical services to and that can get to clinic, should we start billing that as OLP service or continue as we have been?

If the child is receiving clinic services, then it should continue to be billed as clinic. OLP is a distinct service, separate and apart from clinic. OMH has issued a guidance memo that addresses the relationship between OLP and clinic services and can be accessed here:

Source: State February Roundtable 2019

When a youth is hospitalized and an FPSS worker was at the home earlier the same day can Family Peer Support Services (FPSS) bill?

A FPSS provider cannot bill Medicaid for services while the child is in the hospital, as the hospital is already billing Medicaid for the child at that time.

However, if the service is provided before the child was admitted to the hospital, the service would be billable and not duplicative of another Medicaid service.  

As always, we encourage you to speak with your agency internal compliance officer and/or billing staff to delineate when a staff-person can serve the family.

Source: FPSS Preparing for MC Webinar May 2019

Does a caregiver or family member have to be present to bill for children's HCBS Community Self-Advocacy Training and Supports or can you work on the goals with just the enrolled youth?

No, the parent/caregiver does not need to be present to bill for Community Self-Advocacy Training and Supports.

Source: Children's HCBS Webinar Series March 2019

The July 2019 State HCBS billing guidance explains that State designation as a children's HCBS provider is not required for vehicle modification, environmental modification and adaptive and assistive equipment providers. Therefore are these providers and services not applicable to the remedial process?

Consistent with the April 1, 2019, transition, if the FFS authorization process for AT/EMods/ V-Mods has already begun prior to 10/1/19 (meaning the Description and Cost Projection Form has been provided to the LDSS), the process is to be completed through the FFS delivery system.

MCOs are responsible for new requests for these services for eligible enrollees 10/1/19 and forward. New requests for AT/E-Mods/VMods are subject to MCO prior authorization requirements starting 10/1/19, including review for medical necessity of the service.

Source: State Released MMCP FAQ Sept 27, 2019

Are providers allowed to negotiate rates with Medicaid Managed Care Plans (MMCPs) for Children’s HCBS Palliative Care services?

MMCPs are required to pay the government rates for children's HCBS for at least 24 months. By Statute, behavioral health services provided by OMH licensed or OASAS certified agencies are reimbursed at FFS rates through 2023.

Source: State September Roundtable 2019

Should the agency providing Family Peer Support Services (FPSS) submit one claim per child even if two parents attend the group?

The provider can only submit one claim per child, regardless of, if two parents are in attendance in the group session.

Source: FPSS Billing Nov 2019

Can a Family Peer Support Service (FPSS) provider bill for collateral visits (e.g. with a teacher, community provider)?

Yes, as of May 2021 state guidance FPSS may work with collateral contacts to inform and support within Engagement, Bridging, & Transition Support and Community Connections & Natural Supports service components. 

Source: CFTSS September Quarterly 2021

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.

Source: OMH & OASAS CORE FAQ Dec 2021

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.

Source: OMH & OASAS CORE FAQ Dec 2021