Updated Foster Care Provider Education Letter
As a MetroPlusHealth network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) enrolled children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCAs).
Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located at:
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.
The pharmacy benefit requirements include, but are not limited to, rapid replacement of medically necessary prescriptions and transitional fills. Effective April 1, 2023, pharmacy benefits for MMC members, were transitioned to NYRx, the Medicaid Pharmacy program. However, Physician administered drugs, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies are still covered by MetroPlusHealth when billed as a medical or institutional claim. The Pharmacy Procedure Code manual can be found here.
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