Announcing Health Homes Serving Children (HHSC) Revised Rates and High-Fidelity Wraparound (HFW) Rate Implementation
- Announcement is also available in Portable Document Format (PDF)
TO: Health Homes Serving Children (HHSC), Care Management Agencies (CMAs), and Medicaid Managed Care Plans (MMCP) including HIV- Special Needs Plans (SNP)
DATE: October 15, 2024
The New York State Department of Health (NYSDOH) has received approval from the Centers for Medicare and Medicaid Services (CMS) and the New York State Division of Budget to implement Health Homes Serving Children (HHSC) rate changes and High- Fidelity Wraparound (HFW) rates within the HHSC program, effective retroactive to January 1, 2024. The Health Home rate sheet has been updated and posted for Health Homes and MMCPs to reconcile payments. The rates are also summarized below.
For HHSC revised rate, claims with dates of service on or after January 1, 2024, that have already been paid for Fee-for-Service (FFS), payments will automatically be adjusted within check cycle 2459 on October 23, 2024. For Medicaid Managed Care claims for dates of services on or after January 1, 2024, MMCPs must reconfigure payment systems and retroactively adjust paid claims within 90 days of the date of this announcement.
High Fidelity Wraparound:
For both FFS and MMCPs claims, HHSC will submit claim adjustments for dates of service on or after January 1, 2024; for members who received Health Home High- Fidelity Wraparound care management services using the new HFW rate code. 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 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 as located in the MAPP HHTS as outlined High Fidelity Wraparound (HFW) and Early Intervention (EI) Flags in MAPP HHTS.
| Rate Code | Rate Code Description (Decision Model Acuity) | Procedure Code | Modifier | Upstate | Downstate |
|---|---|---|---|---|---|
| 1864 | Health Home Services - Children (Low) (Low (0-5) / Standard (6-21)) | T2022 | U1 | $243 | $276 |
| 1865 | Health Home Services - Children (Medium) Early Development (0-5) / Intensive (6-21)) |
T2022 | U2 | $485 | $553 |
| 1866 | Health Home Services - Children (High) (Complex 0-5 & 6-21) | T2022 | U3 | $809 | $921 |
| 1869* | Health Home Services - Children (Low) (Inc FFP) (Low (0-5) / Standard (6-21)) |
T2022 | U1 | $243 | $276 |
| 1870* | Health Home Services - Children (Med) (Inc FFP) Early Development (0-5) / Intensive (6-21)) |
T2022 | U2 | $485 | $553 |
| 1871* | Health Home Services - Children (High) (Inc FFP) (Complex 0-5 & 6-21) |
T2022 | U3 | $809 | $921 |
| 1867 | High Fidelity Wraparound (HFW) care management | T2022 | U4 | $1,228 | $1,399 |
* 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.
Questions regarding these changes can be sent to HealthHomes@health.ny.gov.
Questions regarding HFW can be sent to OMH.HFW@omh.ny.gov .
