Utilization Management for 1915 © Children’s Waiver Services
6/16/2023
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Posted by Provider Relations
As a reminder, as per NYS guidance for dates of service on or after April 15, 2023, Medicaid Managed Care Plans (MMCPs) are required to deny claims for payment for Children’s Waiver Home and Community Based Services (HCBS) that exceed the initial service period of 60 days, 96 units or 24 hours that have not been authorized by the MMCP via the Children’s HCBS Authorization and Care Management Notification Form.
NYS guidance also required HCBS providers to submit outstanding Children’s HCBS Authorization and Care Management Notification Forms to MMCPs by 3/31/2023 for children/youth who were eligible and enrolled, and already receiving HCBS beyond the initial service period. Upon receipt of a completed form, plans were required to review and make determinations regarding authorization of services requested via the forms within 14 days. Authorizations that were already approved were not impacted by this update.
For more information related to Children’s Waiver Services, please see the following guidance from New York State (NYS).