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Contents
Core Limited Health Related Services
Voluntary Foster Care Agencies (VFCAs) provide clinical functions that do not fall within the traditional Medicaid encounter based billing methodologies. NYS created the Core Services to account for this work. The Article 29-I VFCA Health Facilities Guidelines contains information about staff qualifications, functions and expected staff ratios.
It is expected that VFCAs provide, or make available through a contract arrangement, all Core Limited Health-Related services as well as the required clinical consultation/supervision and administration. The Core Limited Health-Related services as described in this schedule, and the associated billing, apply only to children/youth in the care of a VFCA. All VFCAs must have policies and procedures in place that support the provision of the VFCA Core Limited Health-Related services including a plan for intervention and emergency response 24 hours a day, 7 days a week.
VFCA Health Facilities must provide services by sufficient numbers of staff to provide Core Limited Health-Related services to maintain the physical, mental and psychosocial well-being of each child in its care, as determined by the child’s assessments and treatment plans.
The five VFCA Core Limited Health-Related services play a vital role in assuring
- all necessary health-related services are provided in the specified time frames;
- the child’s parents and caregivers are involved in the planning and support of the treatment, as applicable;
- information is shared appropriately among professionals involved in the child’s care; and
- all health-related information and documentation results in the culmination and implementation of the Comprehensive Individualized Person-Centered Treatment Plan.
The VFCA direct, Core Limited Health-Related services are
- Nursing
- Skill Building
- Medicaid Treatment Planning and Discharge Planning
The VFCA indirect, Core Limited Health-Related services are:
- Clinical Consultation/Supervision
- VFCA Medicaid Managed Care Liaison/Administration
Other Limited Health Related Services
VFCA Health Facilities may provide Other Limited Health-Related services in addition to the Core Limited Health-Related services, including services consistent with treatment plans. The Other Limited Health-Related services may be provided to children in the care of a VFCA, as well as children in foster care placed with an LDSS-certified setting. These Other Limited Health-Related services include:
- Medicaid Home and Community Based Services (HCBS) for children
- Medicaid State Plan services
Medicaid HCBS for Children
Medicaid HCBS for children include the following:
- Caregiver/Family supports and services
- Community advocacy and support
- Respite (planned and crisis)
- Prevocational services
- Supported employment
- Habilitation
- Palliative care
- Accessibility modifications
- Adaptive and assistive equipment
- Customized goods and services
- Health home care management
- Non-medical transportation
Medicaid State Plan Services
Medicaid State Plan services include the following:
- Screening, diagnosis and treatment services related to physical health. This includes but is not limited to:
- Ongoing treatment of chronic conditions as specified in treatment plans.
- Diagnosis and treatment related to episodic care for minor ailments, illness or injuries, including sick visits.
- Primary pediatric/adolescent care.
- Immunizations in accordance with the current NYS or NYC recommended childhood immunization schedule, as appropriate Immunizations.
- Reproductive health care.
- Screening, diagnosis and treatment services related to developmental and behavioral health. This includes but is not limited to the following:
- Psychiatric consultation, assessment and treatment
- Psychotropic medication treatment - Developmental screening, testing and treatment
- Psychological screening, testing and treatment
- Smoking cessation treatment
- Alcohol and/or drug screening and intervention
- Other licensed practitioner
- Crisis intervention
- Community psychiatric support and treatment
- Psychosocial rehabilitation services
- Family peer support services
- Youth peer advocacy and training
- Other services
- Laboratory tests, as specified.
Services Not Included
Other Limited Health-Related Services do not include:
- nursing services,
- skill building activities (provided by LBHPs as described Article 29-I VFCA Health Facilities License Guidelines and any subsequent updates), and
- Medicaid treatment planning and discharge planning, including medical escorts and any clinical consultation/supervision services and tasks associated with the Managed Care Liaison/administrator in 29-I Health Facilities.
These services are included in the Preventive or Rehabilitative Residential supports of the mandatory Core Limited Health-Related Services.
Populations Covered
Other Limited Health-Related Services may be provided to children/youth in the care of any 29-I Health Facility, including children/youth in foster care, children/youth placed in a 29-I Health Facility by Committee on Special Education (CSE), babies residing with their parent who are placed in a 29-I Health Facility and in foster care, and children/youth in foster care placed in a setting certified by the Local Department of Social Services (LDSS).
Children/youth who are discharged from a 29-I Health Facility may continue to receive Other Limited Health-Related Services from any 29-I Health Facility up to one-year post discharge. These services may continue beyond the one-year post discharge date if any of the following apply:
- child/youth is under 21 years old and in receipt of services through the 29-I Health Facility for an Episode of Care and has not yet safely transitioned to an appropriate provider for continued necessary services; or
- the child/youth is under 21 years old and has been in receipt of CFTSS or Children’s HCBS through the 29-I Health Facility and has not yet safely transitioned to another designated provider for continued necessary CFTSS or HCBS in accordance with their plan of care; or
- if the Enrollee is 21 years or older, providers may bill for Other Limited Health-Related Services when the following applies:
- the Enrollee has been placed in the care of the 29-I Health Facility and has been in receipt of Other Limited Health-Related Services prior to their 21st birthday, and the Enrollee has not yet safely transferred to another placement or living arrangement; and
- the Enrollee and/or their authorized representative is compliant with a safe discharge plan; and
- the 29-I Health Facility continues to work collaboratively with the MMCP to explore options for the Enrollee’s safe discharge, including compliance with court ordered services, if applicable.
The Medicaid residual per diem is not reimbursable after the individual’s 21st birthday. Adults over the age of 21 are not eligible for CFTSS or children’s HCBS. For the purposes of this document, Episode of Care is defined as a course of treatment that began prior to one year after the date of the child/youth’s discharge from the 29-I Health Facility, in which Other Limited Health-Related Services had been provided at least twice during the six months prior one year post the date of the child/youth’s discharge from the 29_I Health Facility by the same facility to the child/youth for the treatment of the same or related health and/or behavioral health condition.
OLHRS Fee Schedule
Other Limited Health-Related Services are reimbursed on a standardized fee schedule for services that the 29-I Health Facility provides. 29-I Health Facilities will be reimbursed for Core and Other Limited Health-Related Services by MMCPs for children enrolled in Medicaid Managed Care or by Fee-For-Service Medicaid for children who are not enrolled in Medicaid Managed Care. Agencies without a 29-I licensure Agencies that do not obtain Article 29-I Licensure are not authorized to receive a Medicaid per diem to provide Core Limited Health-Related Service.
Additional Information
Additional details (i.e. service descriptions, staffing requirements, practitioner qualifications, required assessments) for Core Limited Health-Related Services and Other Limited Health Related Services can be found in the Article 29-I Health Facilities License Guidelines Final Draft.