Updates to Billing Requirements for Children's HCBS and CFTSS
12/12/2023
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Posted by Provider Relations
Effective December 1, 2023, NYS is implementing a billing change that will allow claims for Children’s Home and Community Based Services (HCBS) and Children and Family Treatment Support Services (CFTSS) to be paid based on the county in which services were provided, rather than a provider’s corporate headquarters or central office address. This update is necessary to align with the Centers for Medicare and Medicaid Services (CMS) billing requirements, which dictate that services must be reimbursed based on the location of service delivery.
The State has assigned a Federal Information Processing Standards (FIPS) code and a proxy locator code to each county in New York State. The applicable FIPS (if submitting electronically) or proxy locator (if submitting on paper) county code, indicating service location, must be included on all Children's HCBS, CFTSS claims submitted for dates of service on or after December 1, 2023.
Also effective December 1, 2023, the New York State Department of Health (DOH) is establishing rural rates for Children’s Waiver HCBS, per the Centers for Medicare and Medicaid Services (CMS) approval of Amendment NY.4125.R06.01. There are seven upstate counties where the rural rates are applicable: Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, and St. Lawrence. The rate codes and government rates that must be paid by Medicaid Managed Care Plans (MMCPs) are posted to the DOH website at the following link and will be loaded in eMedNY when final state approvals are in place: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/do cs/2023-11-01_hcbs_rate_summary.pdf
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