Frequently Asked Questions

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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

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

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

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

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

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

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

Are Managed Care Organizations (MCOs) required to contract with all Adult providers?

An MCO (both mainstream and Health and Recovery Plans, or HARP) is required to offer contracts to behavioral health programs serving 5 or more of its enrollees. Plans may also offer contracts to providers who serve less than 5 of their enrollees.  For programs licensed by OMH, the requirement is program specific (i.e., contracts must be offered to all of an agency's mental health clinics, but NOT necessarily its Personalized Recovery Oriented Services (PROS) and Continuing Day Treatment (CDT) programs unless each of them also serve 5 or more of its enrollees). An MCO can contract with all of an agency's MH programs even if one or more of its programs did NOT serve 5 or more of the MCO's enrollees. In addition, an MCO is required to put all of an agency's OASAS programs in its network if that same agency has one or more licenses from OASAS and at least one program serving 5 or more enrollees of that MCO.

Additional information on this can be found here, here and here.

Source: Managed Care 101, 7.21.15

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