Children’s Health & BH Roundtable – Mtg Notes

January 31, 2020

Below are brief notes with some highlights from the January 29th Children’s Health and Behavioral Health Managed Care Plan/Provider Roundtable Meeting. We’ll send slides out as soon as they become available.  Note:  These are our notes from the meeting and as such, they represent what we heard.   They do not include back and forth discussions during the meeting or our opinions about the information we received:

·     There are no timeline changes to report. Children and Family Treatment and Support Services (CFTSS) and Youth Peer Support Services are transitioned as of January 1st in Fee for Service and Managed Medicaid.

·     The State reported that a Guidance Letter was issued on 12/27/19 to Crisis Intervention providers.

o   All adult Crisis Intervention providers have been temporarily approved to provide services to children but will have to credential as children’s providers.

o   A soft date to apply to be a CFTSS Crisis provider is February 7th.

o   Instructions for accessing the CFTSS provider application can be found on the Department of Health website, here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/designation_app_access_instructions.pdf

o   As of 1/1/20, all mobile crisis services are billed to CFTSS.

o   Crisis Residential and Telephone Follow-Up are included in the State Plan, but the proposal is still with CMS for SPA approval. State billing guidance is forthcoming.

·     A survey of CFTSS providers was conducted, with 107 responding, about 2/3 of providers surveyed.

o   78% of respondents confirmed that they are providing at least one CFTSS service

o   Of those providing services, 56% report that they’re billing, with claims so far at $2 million

o   Of the 56% reporting billing, 26% of providers report cash flow issues related to claims denials

·     It was reported that 11 providers have de-designated since last reporting, with the majority only de-designating for some services or some counties. Reasons for de-designation include high caseloads, lack of referrals, inadequate workforce, and lack of infrastructure. 13 providers are reported to have de-designated from all services since January 2019.

o   Of the 11 providers, the majority (9) are temporary de-designations

o   If a provider isn’t credentialed to serve health plan members in a specific county, they have been required to de-designate for that county until they are credentialed.

o   New designations include 2 Palliative Care providers in Western NY (Buffalo and Chautauqua), and 1 new multi-service CFTSS/HCBS provider.

·     A summary of Managed Medicaid claims denials was presented.  Notable reporting includes:

o   From October 2019 to December 2019, claims denied due to untimely filing have gone up almost 35%, from 344 to 1584 claims denied.

o   No active coverage at the date of service remains significant, at 9.2%.

o   Untimely filing, duplicate claims, and no prior authorization are the reasons for most denials, in that order.

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And, for those who may have missed it, here is a look at the information we sent to this group (related to some of what is discussed above) on January 15:

Good morning,

We have previously reported to you regarding the proposed SPA amendment submitted by the NYS Department of Health to CMS, modifying requirements for Youth Peer Support and Treatment Services (YPSTS). The full copy of the SPA submission, dated December 31, 2019 in the State Register, can be found here: https://www.health.ny.gov/regulations/state_plans/status/non-inst/index_2020.htm.

At a meeting with advocates and the State on January 14th, it was further clarified that the YPTS and children’s Crisis Intervention (CI) services are live as of January 1st, as per the State’s timeline, with the proposed amendment considered approved, according to DOH, based on their communication with CMS. Providers can bill for services rendered, however payment will be delayed, pending official SPA approval and the subsequent rate approval required by the Department of Budget (DOB).

Enhanced rates for YPTS are now in effect until June 30, 2020.  We have previously reported to you regarding the proposed SPA amendment submitted by the NYS Department of Health to CMS, modifying requirements for Youth Peer Support and Treatment Services (YPSTS). The full copy of the SPA submission, dated December 31, 2019 in the State Register, can be found here: https://www.health.ny.gov/regulations/state_plans/status/non-inst/index_2020.htm.

At a meeting with advocates and the State on January 14th, it was further clarified that the YPTS and children’s Crisis Intervention (CI) services are live as of January 1st, as per the State’s timeline, with the proposed amendment considered approved, according to DOH, based on their communication with CMS. Providers can bill for services rendered, however payment will be delayed, pending official SPA approval and the subsequent rate approval required by the Department of Budget (DOB).

Enhanced rates for YPTS are now in effect until June 30, 2020.  Those rates can be found here:

https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/fpss_bh_kids_ffs_rates.pdf .

Crisis rates and codes remain the same as adult crisis services, including crisis services rate increases effective as of January 1, 2020.  Crisis Intervention rates can be found here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/2019-12-19_child-family_rate_summary.pdf (note that these are the CI rates, although the document is labeled generally as child/family rate summary.