Health Homes Serving Children Providers
UPDATE: Health Homes Serving Children (HHSC) Revised Rates and High-Fidelity Wraparound Rate Implementation
DATE: 10/15/2024 – NYS DOH Memo Release
IMPACTED PLANS: Medicaid and HIV SNP
Dear MetroPlusHealth Provider,
DOH has released guidance of revised rates in the Health Homes Serving Children (HHSC) and High-Fidelity Wraparound (HFW) rate code and rates within the HHSC program, retro-effective January 1, 2024.
MetroPlusHealth systems re-configuration is in progress to process and pay the updated rates and issue retro-active payment adjustments of paid claims for dates of services on or after January 1, 2024.
High Fidelity Wraparound Guidelines:
The HFW rate can only be claimed for children and youth who have the HFW “Flag” in the MAPP Health Home Tracking System (HHTS) and only for the time period in which HFW was provided by a care management agency designated by the Office of Mental Health (OMH) to provide HFW.
Health Homes can retrieve the HFW “Flag” with the respective dates of HFW enrollment and disenrollment within the “Member Program Status Download” and through the “HH CMA Relationship Download” file to obtain the designated HFW care management agencies located in the MAPP HHTS as outlined High Fidelity Wraparound (HFW) and Early Intervention (EI) Flags in MAPP HHTS.
To ensure correct processing and reimbursements, HHSCs should submit claim adjustments for dates of service on or after January 1, 2024; for members who received Health Home HFW, care management services using the new HFW rate code.
State Published HHSC and HFW Billing Codes Table
*Rate codes are separated in the taxonomy to delineate a sub population of children meeting complex trauma criteria. This distinction is not necessary for Medicaid Managed Care Plans and therefore the procedure codes and modifiers are identical.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].
