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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

The VFCA direct, Core Limited Health-Related services are

The VFCA indirect, Core Limited Health-Related services are:

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 HCBS for Children

Medicaid HCBS for children include the following:

Medicaid State Plan Services

Medicaid State Plan services include the following:

Services Not Included

Other Limited Health-Related Services do not include:

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:

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.