Can a person be in both an adult and children's health home with two care managers?
Medicaid for primary care is currently managed care. Behavioral Health is being transitioned and will no longer be carved-out from Medicaid recipient's Managed Care Plans and billed Fee-for-Service.
Please visit https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm for more information regarding the VBP Initiative.
Yes, this is planned. Materials will be developed and shared for providers to use for outreach to families and referral sources.
There are multiple examples of pathways into services including:
The pediatrician can make a recommendation for a service based on their determination of medical necessity. The specific service provider, which may be a pediatrician in some instances, then develops the detailed treatment plan as it relates to the service they are providing.
It is possible a child may have more than one treatment plan if they are receiving multiple services from various providers. However, one treatment plan can be developed for the provision of multiple services when provided by one agency, if their EHR system supports a coordinated treatment case record.
Yes, there will be outreach and education provided to inform the LDSS including an Administrative Directive.
Yes, you need to receive designation to provide Children and Family Treatment and Support Services (formerly SPA) and/or Children's HCBS before you enroll for a provider number such as the Medicaid Management Information System (MMIS).
A Health Home Plan of Care (POC) is a plan for how the care manager helps to arrange for and manage the provision of services by others to assure the various needs of the child are being met.
A Treatment Plan is a document developed by a professional on how they will work with the child and family directly to address their needs based on goals and objectives which are identified by the family, and child, along with the practitioner.
For more information about the differences between treatment/service plans and Plan of Care, see state guidance.
Yes. Certain individual practitioners will now need to enroll as fee-for-service Medicaid providers to remain in Medicaid Managed Care Networks. If the agency is an enrollable type, it must enroll. As indicated on eMedNY Provider Index, OMH provider types that need to enroll include but are not limited to:
OMH Community Residence OMH Licensed ACT Provider
OMH Licensed Outpatient Provider OMH Licensed PROS Provider
OMH Licensed Residential Treatment Facility.
Enrolling and Billing are separate activities and processes. Not everyone who enrolls bills for services. Reiterating, if you are an enrollable type, you must enroll in Medicaid fee for service.
Enrollable types include (partial list):
If the agency is an enrollable type, it must enroll. See eMedNY Provider Index for more information.
Licensed professionals that are enrollable types are required to enroll. This may include but is not limited to
Licensed Master Social Workers and Licensed Mental Health Counselors are not enrollable provider types.
You can find the forms on the website. Provider Maintenance Forms can be found in the Provider maintenance form section. See the eMedNY Provider Index.
MCOs will receive updated monthly lists from the DOH Office of Health Insurance Programs for providers that need to enroll. It is up to the Managed Care Organization (MCO) to contact these providers to enroll. The public can access this list on Health Data website.
Yes, supervisors and managers can be shared across CFTSS. If you are sharing individuals across CFTSS make sure that staff charges/expenses are appropriately allocated. There are not conflict-free requirements restricting supervisors from being shared across CFTSS providers and care managers (this restriction only applies to HCBS), however this is not a recommended practice.
This is not considered a conflict for CFTSS, however it is recommended that individuals be given a choice and only Licensed Practitioner of the Healing Arts (LPHA) can make a recommendation.
It is possible to do batch uploads daily, however this is not recommended. Your organization should determine how often is worthwhile (cost vs. benefit) based on the error rate you are getting. It is a best practice to check the individual’s Medicaid status prior to service delivery and as close to the appointment as possible (e.g. the morning of the scheduled appointment, night before, etc.).
NP LBHP is specific to those practitioner categories that can provide services under OLP. They can make recommendations for any of these services. LPHA is a broader definition and includes additional treating practitioners (i.e. primary care doctor) who can make a recommendation for one of these services.
Please refer to the CFTSS manual for a list of these practitioner types at:
Yes. Non-licensed providers for CFTSS and HCBS that do not have a NPI can use the OMH unlicensed provider number 02249154 or the OASAS unlicensed provider number 02249145
More information on filling out clean claims can be found on MCTAC Billing tool.
Both the organization where care is being provided and identified licensed practitioners individually need to be enrolled as Medicaid providers in order to bill Medicaid if the individual is an enrollable provider type.
For more information, we recommend you listen to and review the following webinar, Medicaid Provider Enrollment for CFTSS and Children’s HCBS webinar.
Any individual practitioner can obtain an NPI number, but only certain practitioner types may enroll in Medicaid to obtain an MMIS number.▼ Expand to view more
Providers already enrolled in Medicaid do not need to re-enroll. The State will add the appropriate Category of Service code for the providers who have been designated for children’s services.
The only time an agency would need to complete a Medicaid application is if the agency is brand new and those providers should refer to the webinar at the following link for more information: Medicaid Provider Enrollment for CFTSS and Children’s HCBS webinar.
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 transitioning Waiver children, the Plan of Care can temporarily serve as the required treatment plan until March 31, 2019.
For more information on the differences between treatment/service plans and Plan of Care, see state guidance.
The new OLP services are intended for children who have not or are not well suited for clinic based treatment, and would be better served in their home or community. OLP services only include assessment, treatment planning, psychotherapy and some crisis interventions. OLP can only be billed for children admitted to the service.
Clinics can offer a full array of clinical treatment interventions, including but not limited to medication management and psychiatric evaluation. Clinic services are to be billed for any child enrolled in clinic.
Yes, eMedNY will be able to determine if a child has SSI on their client file.
Non-licensed staff do not require an NPI. Practitioners who are able and required to enroll in Medicaid will need an NPI to enroll.
Page 91 of the CFTSS Provider Manual outlines which LPHA can make a recommendation for CFTSS:
An individual professional who is licensed as a Registered Professional Nurse, Nurse Practitioner, Psychiatrist, Licensed Psychologist, Licensed Psychoanalyst, Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Marriage & Family Therapist, Licensed Mental Health Counselor, Licensed Creative Arts Therapist, or Physician (per OMH 599 regulations) and practicing within the scope of their State license to recommend Rehabilitation services.
Please note: While all listed LPHA can make a recommendation, not all have the ability to diagnose a child independently, if needed, within their scope of practice without being under the supervision of another qualified licensed practitioner or physician.
A family, teacher, or other non-clinician may refer directly to an OLP without first going to another LPHA.
When a non-clinician refers directly to OLP, the OLP provider will determine whether the child meets the medical necessity criteria to continue receiving OLP and/or recommend for other CFTSS.
The admission date is the earliest date the service is delivered.
These checks are not transferable, all HCBS and Care Managers will require CHCR, SCR and SEL checks even if they were performed previously. See Background Check Guidance document for more information.
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.
FPSS work to improve the situation of the family in relation to the needs of the child. Family peers have lived experience as a parent of a child with mental health needs or substance use needs and the corresponding certification or credentialing. Therefore, the use of a family peer should take into consideration the needs and diagnosis of the child.
Typically, the CRPA-F would assist the parent or caregiver to address the needs of their child with a substance abuse issue. Whereas, the credentialed FPA would work with a parent or caregiver of a child with a mental health need.
Yes, they create the treatment plan based on the needs of the child and family. The FPSS would engage in a conversation with the child and family and use the information provided by the LPHA to determine what intervention/activities would take place within the scope of the service to support the goals and objectives developed.
Although there is no specific assessment for this, OMH does endorse the use of the Family Assessment of Needs and Strengths (FANS) which will assist FPSS providers in honing-in the on a family’s strengths and needs. This conversation would result in the development and implementation of a treatment plan.
More information on the FANS can be found at: https://www.ftnys.org/training-credentialing/family-needs-strengths-fans/
The Crisis/Safety plan is written by the service provider who is delivering the service. This provider must be a designated entity and meet the necessary qualification as identified in the CFTSS Provider Manual.
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.
Yes, children ages 0-21 who are in Medicaid are eligible to receive CFTSS (assuming they meet medical necessity). This includes children ages 18-21 who may also be (or have been) involved in adult services as long as there is no duplication of services. For more on allowable service billing combinations see the billing manual pages 15-17.
The maximum number of individuals that can participate in a group session is 12, regardless of insurance type.
No, if other children are present due to, for example, lack of babysitting and not actively involved they do not count towards the group number.
There should only be 1 note per client/child per session.
The family/caregiver is not a collateral in this instance; others like the school, community members, etc. would be collaterals. Sessions with only collaterals are not allowed for FPSS. Instead, the State encourages FPSS staff to include the family/caregiver in conversations with the school or other collaterals to promote empowerment and skill development.
Family should always be present for the provider to bill for FPSS.
Yes, it includes all active participants, including children and parents.
Yes. If the individual licensed practitioner is Medicaid enrollable, they must enroll and use their individual NPI number on claims.
If the individual practitioner is unlicensed or not a licensed enrollable Medicaid practitioner the OCFS (05448682) unlicensed practitioner ID may be used.▼ Expand to view more
The transition to a value based system is still in development. Be sure to listen to State and Federal government guidance as well as your managed care plans. Currently, by the 5th and final year of the DSRIP program (2019), all managed care organizations must employ value based payment systems for at least 80-90% of their provider payments.
Additional information provided by the New York State Department of Health can be found here.
Please see the MCTAC Matrix for further information on MCOs in each region.
Small providers should start with where they are and what resources they have. Utilize board members to help with certain tasks or get further financial commitment from the board to help with the process of contracting and preparing for managed care services. In other states, nonprofits have formed affiliations, partnerships or collaborations to use shared infrastructure to help with tracking outcomes, billing, etc.
A recovery-based mental health system embraces the following values: self-determination, empowering relationships based on trust, understanding and respect, meaningful roles in society, and elimination of stigma and discrimination.
The Substance Abuse Mental Health Services Administration, or SAMHSA, offers additional information here.
LOCADTR is the patient placement criteria system that must be used in making substance use disorder (SUD) level of care decisions in New York State (NYS). LOCADTR assesses the intensity and need of services for an individual with an SUD. All OASAS providers and Medicaid plans will be required to use this tool.
Additional information can be found on OASAS' website.
In New York, the state has imposed an MLR of 89% for its Medicaid Managed Care program. This means that 89 cents of every dollar that flows from the state to the MCOs must be used to pay providers for services and not MCO administrative or marketing costs. If this figure is not met, funds return to the state and a legal process follows. The goal of this standard is to get behavioral health dollars out to providers.