Will Managed Care Organizations know who the designated adult Home and Community Based Services (HCBS) providers are? How do providers find out who the adult HCBS providers are?
Yes, Plans are provided this information and when available the list of the adult designated providers is also publicly available on the OMH website, and can be accessed here.
How do agencies identify if an adult client is HARP/HCBS eligible?
HARP/HCBS eligiblity information is available using ePaces.
What will be done to ensure that adults interested in CORE are offered a choice of providers without conflict free care management?
For referrals made by Health Home Care Managers (CM) the CM will ensure that the member is offered a choice among all in network providers in accordance with the Health Home standards. The State strongly encourages other referral sources to educate members and facilitate an opportunity for an informed choice. As with any other benefit, individuals may choose to access CORE services from any in network provider.
Will a Plan of Care (POC) be required for CORE services?
A Health Home Plan of Care will not be required for CORE services. CORE services must be documented in an Individual Service Plan (ISP) maintained by the CORE services provider.
For CORE services, what is the purpose of the LPHA recommendation?
The purpose of the LPHA recommendation is to determine and document medical necessity for CORE Services.
Do I need to send the LPHA recommendation for CORE services to the Managed Care Organization (MCO)?
Providers are not required to submit LPHA recommendation to MCOs in order to begin providing CORE services. From time to time, MCOs may request a copy of the LPHA recommendation, just as they may request any other documentation from the case record.
Can a staff at an MCO do the LPHA recommendation for CORE services if they meet the minimum requirements for a LPHA?
At this time, the LPHA recommendation form cannot be completed by staff at the MCO. However, MCOs play an essential role in connecting their members to CORE Services by referring them to in-network providers.
What needs to be in a CORE referral? Will there be a template?
There is no set template for CORE referrals. The CORE provider should define their own referral and intake/eval processes, including what information or documents are needed with a referral. The process should be simple and follow a “No Wrong Door” policy. Providers must establish their process in a formal Policy & Procedure.
Who can make a referral to CORE services?
With the No Wrong Door referral pathway, anyone can make a referral including the prospective client (self-referrals). Referrals are not required to come in with an LPHA recommendation.
How do CORE providers notify Managed Care Organizations (MCOs) about an individual initiating CORE Services?
CORE providers must notify an enrollee’s MCO within three business days after their first date of initiating a new CORE Service, which includes CORE Service Intake and Evaluation.
MCOs must implement a secure electronic process for receiving and responding to CORE Services initiation notifications. NYS developed a template containing the information providers must submit to MCOs. See the CORE Service Initiation Notification Form for additional information. MCOs may use this template or develop their own but can only include information contained in the template. MCOs are expected to clearly communicate and provide any necessary training to their CORE provider network about the specific MCO’s notification process.
What will happen if the CORE Service Initiation Notification Form is submitted after the 3-business day timeframe?
CORE providers must notify an enrollee’s MCO within three (3) business days after the first date of initiating a new CORE Service. This allows for the MCO to identify any concerns regarding duplication of services. If the CORE Service Initiation Notification Form has not been submitted, an MCO may pend (or hold) the claim. The MCO will then reach out to the provider to request submission of the Service Initiation Notification Form. Providers should be aware that if the MCO identifies a duplicative service and the form was not submitted on time, claims may be denied.
Has “progress made/follow up” been eliminated from the progress notes for CORE? If so, how do we document progress made as well as follow-up/next steps?
Yes, this section of the progress note is no longer required. Progress made should be regularly monitored and documented in the ISP review summaries.
Do supervisors need to sign off on CORE encounter/progress notes?
The service encounter note needs to have the name, qualifications, dated signature of the staff person delivering the service. Although it is not required for a supervisor to sign off, an agency can choose to do so to ensure notes meet billing requirements.
What is NIMRS and how do I sign up? What incidents do I have to report for CORE?
NIMRS stands for the New York State Incident Management and Reporting System. NIMRS is a secure, web-based, quality management tool used by OMH-hosted providers to report incidents. Incident Reporting and Management Guidance for CORE and BH HCBS was issued via the BH HCBS Listserv on 12/13/21 and was effective immediately. Additional information for OMH-hosted providers can be found on the Division of Quality Management website.
Is there a centralized list of current CORE Services providers?
A list of Designated CORE Service Providers is located on the CORE Website.
Will existing CORE providers have the opportunity to add new services to their designations?
The State anticipates accepting expansion applications from existing CORE providers in the coming months. Interested providers should contact the mailbox to discuss the process.
What are non-billable contacts related to CORE, do I need to document those?
Non-billable contacts, for example outreach to disengaged members, appointment reminders, or contacts that do not reach minimum service duration, are critical to engaging the person in CORE services. These contacts are documented in a contact log, case note, or non-billable progress note. Providers have some discretion in which non-billable contacts are documented. For example, routine appointment reminder calls or texts might not be documented, but a letter attempting to outreach to a disengaged individual should be noted.
Documentation on non-billable contacts helps demonstrate the quality of services provided and is particularly helpful during times of staff-turnover.
Do we need to make changes in our Electronic Health Record (EHR) or Electronic Billing Software (EBS) in order to meet the documentation requirements for CORE?
In developing documentation requirements for CORE Services, the State used the 2016 BH HCBS Behavioral Health Information Technology (BHIT) technical specifications as a guide. The intent was to minimize disruption or changes to existing software. The State will issue updated technical specifications that will support agencies in making any needed changes, including new modifiers and rate codes that will need to be added for certain services.
For the CORE Case Record, form fields can be named/labeled differently as long as all required elements are included in the content of the documentation to support appropriate billing.
Can a LMSW who does not have a NPI complete the LPHA Recommendation Form for CORE?
An LMSW practicing under the supervision of an LCSW, licensed psychologist, or licensed psychiatrist is qualified to complete the LPHA Recommendation Form, even if they do not have an NPI. In this case, the LMSW should enter their license number on the recommendation and indicate on the form that a license number has been used instead. Please note that all Medicaid practitioners including Certified Peers and LMSW can apply to get an individual NPI at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/apply