Frequently Asked Questions

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Can a person be in both an adult and children's health home with two care managers?

No.

Source: Children's System Transformation, Elmira, 4.13.16

Is Medicaid a managed care system already?

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.

Source: Children's System Transformation, Poughkeepsie, 3.31.16

How will the Value Based Payment system work?

Please visit https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm for more information regarding the VBP Initiative. 

Source: Transforming the Children's Medicaid System Webinar Part 3, 2.25.16

Can Other Licensed Practitioner (OLP) be provided under a limited permit license?

No.

Source: CFTSS June 2018

Will there be outreach to the medical community, school districts, etc. about the Children and Family Treatment and Support services, referral process and medical necessity?

Yes, this is planned. Materials will be developed and shared for providers to use for outreach to families and referral sources.

Source: CFTSS June 2018

From a Workflow perspective, how do you get into these services without going through an Other Licensed Practitioner (OLP)?

There are multiple examples of pathways into services including: 

  • If the child is in clinic receiving therapy, the clinician can make a recommendation for any of the new Children and Family Treatment and Support Services based on their determination of medical necessity.                
  • A pediatrician can directly recommend FPSS as they can support medical necessity.  
  • A school guidance counselor supporting a young man/woman who has come back from a residential setting with a parent who is concerned about positive peer group. The school counselor could refer any agency who providers PSR. The agency can access their own internal licensed practitioner for assessment and determination of medical necessity or work with the parent to identify a treating clinician for documentation of medical necessity to allow the service.
  • In foster care there is a requirement that youth have a full array of health and behavioral assessments by licensed practitioners, which could result in a recommendation for one or more of these services.

Source: CFTSS June 2018

Can a pediatrician make a recommendation for Children and Family Treatment and Support Services and develop a treatment plan?

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. 

Source: CFTSS June 2018

Could a child have more than one treatment plan if they are receiving multiple Children and Family Treatment and Support services?

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.

Source: CFTSS June 2018

Is there a process/plan to educate the Local Departments of Social Services (LDSS) on the new and aligned children's services?

Yes, there will be outreach and education provided to inform the LDSS including an Administrative Directive.

Source: Children's Aligned HCBS June 2018

Do we need to receive designation to provide Children's CFTSS/HCBS before we enroll for a provider number such as the Medicaid Management Information System (MMIS)?

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).

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What is the difference between a Health Home Plan of Care and a Children and Family Treatment and Support Services Treatment Plan?

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.  

Source: CFTSS June 2018

Historically, staff of OMH-licensed programs do not have to register individually to bill within a program. Has the requirement changed due to the 21st Century Cures Act?

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.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What type of licensed organizations/programs are required to enroll as Medicaid providers?

Enrollable types include (partial list):

  • OMH Community Residence 
  • OMH Licensed ACT Provider
  • OMH Licensed Outpatient Provider 
  • OMH Licensed PROS Provider
  • OMH Licensed Residential Treatment Facility 
  • Chemical Dependency Program (CDP)
  • OASAS Part 820 Residential Treatment Program
  • Bridges to Health Waiver Providers
  • Children's System Transformation Providers:
    • Children and Family Treatment and Support Servicces
    • Children's Home and Community Based Services

 

If the agency is an enrollable type, it must enroll. See eMedNY Provider Index for more information.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What licensed professionals providing care at enrolled organizations are required to enroll as Medicaid providers?

Licensed professionals that are enrollable types are required to enroll. This may include but is not limited to

  • LPNs and RNs
    • They can enroll as OPRA non-billing if in a facility. They will be listed as an Attending provider on the claim. 
    • If the nurse is a billing provider on a private duty nursing case, the nurse must enroll as a fee-for-service billable provider.
  • Physicians 
  • Nurse Practitioners 
  • Physician Assistants
  • Clinical psychologists
  • Licensed Clinical Social Workers

Licensed Master Social Workers and Licensed Mental Health Counselors are not enrollable provider types. 

See eMedNY Provider Index

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

Where are the forms for Medicaid Provider Enrollment?

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.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

How will Managed Care Organizations (MCOs) address rostered providers at facilities that need to enroll but have not?

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.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

Can supervisors be shared across services for Children and Family Treatment and Support Services (CFTSS)? What about case managers?

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. 

Source: July 2018 CFTSS Billing In-Person Training

At an OMH licensed clinic can someone other than the Other Licensed Practitioner (OLP) recommend to the Children and Family Treatment and Support Services (CFTSS) within the same agency or is that a conflict?

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.

Source: July 2018 CFTSS Billing In-Person Training

How often do you recommend doing a batch upload to check Medicaid eligibility?

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.).

Source: July 2018 CFTSS Billing In-Person Training

For CFTSS, what is the difference between LPHA and NP-LBHP?

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: 

https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/updated_spa_manual.pdf

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

Can non-licensed providers for CFTSS and children's HCBS, that do not have a NPI, use the unlicensed provider number?

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.

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

How do you become a Medicaid provider as part of an agency?

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. 

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Source: July 2018 CFTSS Billing In-Person Training

Does a provider need a different Medicaid number as a Children and Family Treatment and Support Services provider if they are currently an enrolled provider for a program (i.e. PROS)?

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. 

  

Source: July 2018 CFTSS Billing In-Person Training

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 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.

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

What is the difference between OLP services and therapeutic services through the Article 31 clinic? How do we distinguish when each is appropriate/when to bill for which?

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. 

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

Will there be a Mental Health indicator on ePACES to indicate SSI? In addition, will eMedNY know to lift the edit for these CFTSS rate codes if Mental Health in on the profile?

Yes, eMedNY will be able to determine if a child has SSI on their client file. 

Source: CFTSS: OLP, PSR, CPST Billing Update 11.6.18

Can individuals providing CFTSS or children's Aligned HCBS who are not licensed practitioners get NPIs?

Non-licensed staff do not require an NPI. Practitioners who are able and required to enroll in Medicaid will need an NPI to enroll. 

Source: State January Roundtable 2019

What is within the scope of an LPHA’s practice as related to recommending CFTSS?

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.

Source: State January Roundtable 2019

Can a child's family or teachers directly refer to an OLP?

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.

Source: State January Roundtable 2019

Is the date that medical necessity is determined considered the “admission date”?

The admission date is the earliest date the service is delivered.

Source: State January Roundtable 2019

Do all current children's HCBS providers need new fingerprinting and background checks even if they have had them previously?

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.

Source: Children's HCBS Webinar Series March 2019

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

If a family does not have a child with a substance abuse issue would a Certified Recovery Peer Advocate Family (CRPA-F) be able to work with the parent to provide Family Peer Support Services (FPSS)?

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. 

Source: FPSS Preparing for MC Webinar May 2019

Does the Family Peer Advocate (FPA)/Certified Recovery Peer Advocate Family (CRPA-F) write the treatment plan?

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/

Source: FPSS Preparing for MC Webinar May 2019

The documentation does not say that the LPHA who makes the Family Peer Support Services (FPSS) recommendation "MUST" be involved in the creation/coordination/oversight of the treatment plan and most clinicians (pediatricians/school SW/LPHAs) are not going to want to have more responsibility than is required. What is the protocol in these situations? Can FPSS providers create their own treatment plans with caregivers and submit them to the Medicaid Managed Care Plan (MMCP) without the oversight of any other authority?

The FPSS provider can develop their own treatment plan, with the oversight and approval of the FPA supervisor.  The plan, however, should be guided by the needs and functional limitation of the child identified by the recommending LPHA.
Ongoing involvement of the LPHA recommending the CFTS service is not required. However, as with all mental health service provision, coordination of care between service providers or through a multi-disciplinary approach, is most effective.
If the recommending LPHA is also part of the FPSS provider agency, they may play a more active role in the treatment plan and serve as a member of the multi-disciplinary team on an integrated treatment plan.  
If the LPHA is not within the same agency, wherever possible, FPSS providers are encouraged to coordinate with external agencies to ensure their work supports the efforts of other treatment providers and helps to inform their own activities. 

Source: FPSS Preparing for MC Webinar May 2019

Who writes the Crisis and Safety Plan for the child as part of CFTSS Crisis Intervention?

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.

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

Can a child/youth receive CFTSS services after they turn 18 and become eligible for some adult services? Can a 19 year old start to receive adult services and then decide CFTSS would suit them better and return to CFTSS until they age out?

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. 

Source: YPST Webinar 11.18.19

What is the maximum number of individuals that can participate in a CFTSS Family Peer Support Services (FPSS) group session?

The maximum number of individuals that can participate in a group session is 12, regardless of insurance type.

Source: FPSS Billing Nov 2019

Does the maximum number of individuals participating in a CFTSS Family Peer Support Services (FPSS) group session include children not actively participating, who happen to be there with their parents?

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. 

Source: FPSS Billing Nov 2019

Is a group note required as well as an individual note for each child/youth you bill for in an Family Peer Support Services (FPSS) group session?

There should only be 1 note per client/child per session. 

Source: FPSS Billing Nov 2019

Is Family Peer Support Services (FPSS) technically a collateral service because it works with the parent rather than the child?

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.

Source: FPSS Billing Nov 2019

Does the maximum number of individuals participating in a CFTSS Family Peer Support Services (FPSS) group session include children participating with parents in a FPSS parenting group?

Yes, it includes all active participants, including children and parents.

Source: FPSS Billing Nov 2019

Do OPRA requirements apply to Article 29-I Facilities?

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.

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Source: 2.10.21 Article 29-I Billing Office Hour

How will providers transition from the Fee-For-Service(FFS) system to the value based system?

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.

Source: RCM/UM/Outcomes Event: Albany 5.29.15

Is there a list of Managed Care Organizations (MCOs) in each region?

Please see the MCTAC Matrix for further information on MCOs in each region.

Source: Contracting

With multiple payers and multiple contracts how can small organizations survive and even thrive?

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.

Source: Contracting

What is the definition of "recovery-based"?

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.

Source: Managed Care 101 7.22.15

What is Level of Care for Alcohol and Drug Treatment (LOCADTR)?

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.

Source: MCTAC Kick-Off Forum, 1.23.14

What is a Medical Loss Ratio (MLR)?

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.

Source: UM for OASAS Programs, 10.5.15 AM Session