UPDATE Health Home Serving Children Level of Support (Acuity) Adjustments
January 16, 2025, UPDATE January 30, 2025
- Announcement is also available in Portable Document Format (PDF)
To: Health Home Serving Children, Care Management Agencies, and Medicaid Managed Care Plans (MMCPs) including Mainstream Managed Care and HIV Special Needs Plans
UPDATE: The purpose of this announcement is to clarify that, for children whose acuity score was adjusted based on the CANS-NY 2.1, the Health Homes are permitted to bill the new level until the revised algorithm is implemented in the Uniform Assessment System (UAS), as long as the core requirements for the acuity score assigned under the CANS 2.0 were met. Care managers are reminded that the core monthly requirements per the CANS-NY acuity is the minimum requirement and that care coordination services should be delivered based upon the needs and requests of the member/family.
January 16, 2025, Issued Announcement:
After the launch of the updated CANS-NY 2.0 in November 2023, Health Homes identified discrepancies in the care coordination level assigned by CANS 2.0 and the level of care coordination they believed was necessary to provide appropriate support to the child. The Department of Health (DOH) conducted a comprehensive data analysis and case review with stakeholders, which determined that the CANS-NY 2.0 does not always capture both the social and clinical complexity of some children in determining the assigned acuity level. As a result, the CANS-NY algorithm has been updated, which will be referred to as CANS-NY 2.1 Care Coordination Level of Support. The roll-out of the update to CANS-NY 2.1 Care Coordination Level of Support will occur in two phases.
Assessments Finalized Between November 14, 2023, through November 30, 2024
In the first phase, outside of the UAS and MAPP, DOH applied the CANS 2.1 Care Coordination Level of Support to CANS-NY 0-5 and CANS-NY 6-21 assessments signed/finalized between November 14, 2023, through November 30, 2024, to identify assessments that were assigned a lower acuity than determined by the new CANS-NY 2.1 algorithm. The UAS has been updated to show the new Care Coordination Level of Support and will be transmitted to MAPP Health Home Tracking System on or around January 6, 2025. A list identifying impacted assessments will be transmitted to Health Homes on or around January 15, 2025.
Health Homes Serving Children (HHSC) will receive a list of assessments by care management agency identifying individual members whose Care Coordination Level of Support have been increased. HHSC will be permitted to adjust previously submitted claims to reflect the new acuity value if the core requirements in effect during the billing month for the previous acuity level was met. HHSC must use the list provided by DOH to identify billing instances to be voided and then resubmitted to the MAPP Health Home Tracking System for these members, which will trigger the system to re-calculate the member's rate, based on the adjusted acuity. The HHSC will then adjust the paid claims associated with each member and month(s) that were affected.
Assessments Finalized After November 30, 2024
CANS-NY 0-5 and CANS-NY 6-21 assessments signed/finalized AFTER November 30, 2024, will be corrected with the next release update to the UAS, which is tentatively scheduled for the beginning of March 2025. Until the next UAS release occurs, all completed CANS-NY will continue to reflect the CANS-NY 2.0 acuity. After the UAS release, HHSC will be permitted to re-submit claims to reflect the corrected acuity of assessments completed after November 30, 2024, and before the UAS release.
Medicaid Managed Care Plans are requested to waive timely filing until May 30, 2025, and promptly pay these adjusted Health Home Serving Children's claims due to the adjustment to the Care Coordination Level of Support.
Questions can be sent to: https://apps.health.ny.gov/pubpal/builder/email-health-homes using the subject "Care Management/Health Home Core Services- HHSC ONLY".
