Information for Providers Regarding Enrollees in Foster Care
12/13/2021
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Posted by Provider Relations
As a Fidelis Care network provider, you may find yourself in a position to provide services for a new group of Medicaid Managed Care (MMC) enrollees who require trauma-informed care: children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCA).
In 2013, children/youth in direct placement foster care in counties outside of New York City were mandatorily enrolled in MMC. Effective July 1, 2021, children/youth in direct placement foster care in New York City and children/youth placed in foster care in the care of VFCAs statewide, are mandatorily enrolled in MMC unless the child/youth is otherwise exempt or excluded from enrollment. In addition, effective July 1, 2021, the MMC benefit package expanded to include Article 29-I VFCA Health Facility services for eligible children and youth.
As a network provider, you may be responsible for providing and/or coordinating services for children/youth in foster care, in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual, and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located at: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.
The pharmacy benefit requirements for children/youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions, transitional fills for children/youth newly placed in foster care, and out of network access to pharmacies when a child/youth placed in foster care is placed outside the MMC Plan’s service area.
In addition, upon placement into Foster Care, a child/youth is required to have an Initial Medical Assessment within the first 30 days of the child/youth’s placement. The child/youth may utilize any primary care physician (PCP) or qualified practitioner in the MMC Plan’s network for the purposes of this Initial Medical Assessment. For future primary care visits, if there is a discrepancy with the assigned PCP on the card please immediately call Fidelis Care at 1 (888) 343-3547.
Please see the May 2021 Medicaid Update Article related to this VFCA transition link provided here: Changes Impacting Providers Serving Children Effective July 1, 2021.