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.
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.
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.
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.
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.
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.
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.
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.
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.
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.