UPDATED High Fidelity Wraparound (HFW) Core Requirements within the Health Home Serving Children's Program
December 23, 2024, UPDATED January 27, 2025
- Announcement is also available in Portable Document Format (PDF)
TO: Health Home Serving Children, HFW Care Management Agencies
UPDATE: The purpose of this announcement is to clarify HFW requirements for billing prior to January 1, 2025.
On October 15, 2024; the NYS Department of Health issued Announcing Health Homes Serving Children (HHSC) Revised Rates and High-Fidelity Wraparound (HFW) Rate Implementation which allows retroactive HFW billing for dates of service on or after January 1, 2024. However, Health Homes should only bill the HFW rate if the enrolled member's CANS-NY acuity monthly core requirements were met during the period of January 1, 2024, through December 31, 2024. Please note that changes to monthly core requirements for billing the HFW rate on or after January 1, 2025, are outlined below in the original announcement.
December 23, 2024, Issued Announcement:
Effective January 1, 2025, Care Management Agencies providing High Fidelity Wraparound (HFW) care management services designated by the Office of Mental Health (OMH), will have to meet the HFW core requirements to receive the per member per month (PMPM) rate.
High Fidelity Wraparound (HFW) core requirements, as outlined in the "Health Home Serving Children Care Management Core Service Requirements and Billing Policy HH0017", are four completed core services per month, one of which includes the Child and Family Team Meeting (CFTM). Each of the four core services must be contacts with the member/caregiver. Two contacts must be with the member and two contacts may be with the caregiver based upon the current needs of the member and caregiver and what is needed to support progress on the plan of care. The member and the caregiver must be in attendance at the CFTM. The CFTM counts as one contact. At least two member/caregiver contacts per month must be in person, one of which must be with the member, and at the request of the member/caregiver, up to two contacts per month may be via telehealth. The CFTM may occur via telehealth at the request of the member/caregiver. If the CFTM is in person with the member, it can serve as the required monthly in-person member contact.
Additionally, the Child and Family Team Meeting (CFTM), which serves as the Interdisciplinary Team Meeting (IDT), must occur monthly, except during the first month of enrollment in HFW. Fidelity standards allow for up to 40 days to conduct the initial CFTM while intensive engagement activities are occurring to build the team.
This effective date of January 1, 2025, requiring the completion of the core requirements for HFW billing, supersedes the effective date of April 1, 2025; on billing policy HH0017 and only applies to HFW care management. Agencies must meet these requirements to continue billing the enhanced HFW PMPM rate effective January 1, 2025.
Since the care management agency's Health Home may not have their electronic health records and billing platforms configured for these changes, it is the responsibility of the HFW care management agency to properly document compliance with these core requirements and not bill the HFW PMPM rate if they are not met in each month.
Any questions should be submitted to OMH: OMH.HFW@OMH.NY.GOV
