Frequently Asked Questions

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General Managed Care
Utilization Management
CFTSS and Children's HCBS
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In CFTSS if the youth is enrolled in Health Home Care Management, does the Plan of Care replace the treatment plan?

No. The Health Home Care Manager determines what services are needed, facilitates referrals, and develops a HH Plan of Care. The treatment plan is developed by the treating practitioner who provides the direct services. The Agency/practitioner providing direct services is responsible for maintaining the treatment plan. 

For more information on the differences between treatment/service plans and Plan of Care, see state guidance.

Source: UM for CFTSS: OLP, PSR, CPST 9.18.18

Can a child be recommended for HCBS and CFTSS?

Yes, a child may meet criteria for both based on medical necessity for CFTSS and meeting HCBS threshold criteria.  The Health Home Plan of Care should identify what goals each service is intended to address.  Each service would have its own service or treatment plan.  

Source: Children's HCBS Webinar Series March 2019

Should a Plan of Care (POC) be sent to Medicaid Managed Care Plans (MMCPs) for all Health Home enrollees, or just those in receipt of Children’s HCBS?

POCs for children/youth who are enrolled in HCBS need to be sent to the MMCP. POCs for Health Home-only enrollees are typically sent to the MMCP upon the MMCP’s request.

Source: State Children's Waiver HCBS Workflow FAQ 2019