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.
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.
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.
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.
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.
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.
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: https://omh.ny.gov/omhweb/bho/omh_clinic_and_olp.pdf
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.)
Will Youth Peer Support and Crisis Intervention (CI) be billable to the Medicaid Managed Care Plans (MMCPs) on 10/1/19 under the consolidated waiver even though they won’t be CFTSS until January 2020?
Youth Peer Support and Crisis Intervention are part of the Children’s HCBS package until January 2020 when the services become CFTSS.
When the HCBS package moves into Medicaid Managed Care (MMC) on 10/1/2019, all HCBS for children who are enrolled in MMC will be billed to MMC.
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.
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.
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.
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.
Can a Family Peer Support Service (FPSS) provider bill for collateral visits (e.g. with a teacher, community provider)?
Collateral billing is not allowed for FPSS and not listed as an allowable modality in the CFTSS Provider manual.