Serving and Billing for Children who are Dually Eligible for Health Home Serving Children and Early Intervention Services

Questions and Answers

Background: The New York State (NYS) Department of Health (DOH) Health Home Serving Children's (HHSC) Program in collaboration with the Bureau of Early Intervention (BEI), announced that effective July 1, 2024, children who are eligible for both Health Home and Early Intervention services may be enrolled in both programs and providers may submit claims for all services delivered, including case management. The following information is being provided as clarification for impacted Health Home Care Managers, Early Intervention Program Service Coordinators, and Early Intervention County Officials.

1. Question: After July 1, 2024, how shall a dually designated agency proceed with claiming for children who are currently enrolled in both the Early Intervention and Health Home Programs?

Response: When a family wants to utilize the services of a dually designated agency and such agency has capacity, then the dually designated agency can submit claims for Health Home care management billed at the established per member per month (PMPM) rate and for Early Intervention service coordination. Standard Medicaid and Program billing rules for each program (Health Home Serving Children and Early Intervention) apply. Documentation for each activity must be retained per the documentation and billing requirements established by each program. Health Home care management and Early Intervention service coordination documentation must be maintained for each program when such services are provided.

2. Question: When using a dually designated agency will there be an Early Intervention service authorization for more than one (1) unit of service coordination?

Response: Yes, the Individualized Family Service Plans (IFSP) for those children who have Early Intervention service coordination provided by a dually designated agency will need to be reviewed and the service authorization amended to reflect the number of Early Intervention Program ongoing service coordination units that will be required to accomplish Early Intervention Program specific service coordination activities during the course of the child's current Individualized Family Service Plans (IFSP)The service coordinator should work with the family and the child's assigned Early Intervention Official-Designee to review and amend the service authorization as appropriate. Only Early Intervention billable service coordination activities should be entered into the state data system (NYEIS or EI-Hub) for claiming. Information about Early Intervention Service Coordination billing activities can be found in the Early Intervention Program Guidance Document

3. Question: Are children eligible for Health Home and Early Intervention Services required to use a dually designated agency?

Response: No. If a dually designated agency is not available, does not have capacity to accept the child, or the family does not want to receive services from a dually designated agency, the child/family can be served by both a Health Home Care Manager (HHCM) for comprehensive care management and an Early Intervention Ongoing Service Coordinator for early intervention service coordination activities.

4. Question: How are Health Homes Serving Children and Early Intervention Providers paid when they are both serving the same child?

Response: The Health Home Care Manager may bill the monthly per member per month Health Home rate for the child for meeting the Health Home core service requirements and the Early Intervention Ongoing Service Coordinator may bill for early intervention for any billable service coordination activities completed according to the service coordination billing requirements.

5. Question: If there are two agencies serving a child, will the Health Homes Care Management agency be permitted to access the child's IFSP through New York Early Intervention system or Early Intervention Hub? Will the Early Intervention Service Coordinator be permitted to access Health Home case management data systems?

Response: No. A Health Home Care Manager cannot be granted access to the Early Intervention Program data system (New York Early Intervention System or Early Intervention Hub. Early Intervention Service Coordinators cannot be granted access to Health Home Case Management systems. We would expect that both parties would have written consent signed by the parent/caregiver/guardian to share information, including a hard copy of the IFSPs and Health Home Plan of Care, and to ensure communication and effective coordination between programs. An Individualized Family Service Plans service authorization is only needed for service providers who are dually designated agencies assigned to the child or for Early Intervention approved service coordination agencies to bill for the services that they are authorized for.

6. Question: Are there any resources available on Medicaid billing for dually designated agencies?

Response: Approved dually designated Health Homes Serving Children and Early Intervention Program agencies will bill utilizing the New York Early Intervention Data System (NYEIS) and Early Intervention Hub when the system is launched on 10/15/24. Approved providers can locate information on billing for Early Intervention Program service coordination services in the following resources:

NYEIS -The New York Early Intervention Data System
The New York Early Intervention Data System Resource Documents - New York Early Intervention Data System User Manual, The New York Early Intervention Data System Targeted Resources, the New York Early Intervention Data System Data Change Request and the New York Early Intervention Data System Feature Request documents are located in the New York Early Intervention Data System folder on the New York State Department of Health Commerce System (HCS). These documents can be accessed regularly and downloaded locally to your computer.

The New York Early Intervention Data System Help Desk is available for any questions related to the New York Early Intervention Data System. Trained specialists are available to assist with general information regarding NYEIS as well as troubleshooting.

New York Early Intervention Data System Help desk: (CMA contractor) 518-640-8390 or Toll free 1-833-395-7058 or by email sent to:nyeis@cma.com

Early Intervention Hub: Those who will be completing billing and claiming for Early Intervention Program services through Early Intervention Hub (after 10/15/24) should visit PCG's learning management system (LMS) and self-register for the learning management system here: https://nyeihub.pcghuslms.com/login/signup.php. The learning management system contains training resources for Early Intervention Hub.

State Fiscal Agent - PCG:
The website for more information regarding billing and claiming is www.eibilling.com.

Approved providers can find information on billing for Health Home care management services in the following resource: Health Home Billing (ny.gov)

7. Question: When a child is served by a dually designated Health Home/Early Intervention (HHCM/OSC) provider, is the provider required to keep two sets of notes, one for the Early Intervention Program and the other for Health Homes? 

Response: No. There is no requirement that a dually designated HHCM/OSC provider keep separate child records (one for Early Intervention documentation and the other for Health Homes documentation). A dually designated HHCM/OSC provider must document their care management/service coordination activities in accordance with each program's documentation requirements.

Dually designated providers utilizing a single record should be mindful that they may need to redact information from the notes prior to sharing to remain consistent with any applicable confidentiality and privacy rules. For example, if a child's case notes in their Health Home case record specifically talk about the needs of another family member, that part of the record may need to be redacted when shared with the County Early Intervention Official (EIO).

8. Question: Is a dually designated provider to remit case notes to a municipality or the New York State Bureau of Early Intervention when requested?

Response: Yes. The NYS Early Intervention Provider Agreement, signed by the dually designated provider, requires the dually designated provider to provide all records and case notes to the county Early Intervention Official (or Designee) as the county is the authority that authorized Early Intervention services within the county for the purpose of monitoring and quality assurance. Early Intervention Program regulations require that the provider of authorized service coordination services submit documentation to support billing and claiming for early intervention services rendered.

9. Question: To what extent are the two systems expected to share the child's complete service plans?

Response: It is expected that the Health Homes Care Manager and the Early Intervention Service Coordinator will share complete service plans including all services that the child is receiving in both programs. Both parties should have written consent signed by the parent/caregiver/guardian to share information, including Individualized Family Service Plans and Home Health plans of care, and to ensure communication between programs. This ensures that the identified needs of the child and family are being met by the appropriate program and that the child and family's care is truly being coordinated.

10. Question: If a child needs speech or physical therapy, can these services type be- authorized and reimbursed under the Health Home? 

Response: The Health Home care manager coordinates services with providers to meet the child's needs and these providers do not get reimbursement through the Health Home program, they would have to bill to the child's insurance and or Medicaid. If the child has identified needs of speech or physical therapy, then the Health Home care manager needs to assist with connecting the child to those services through Early Intervention or through other community service providers.

11. Question: Where would I find information on how an agency can be confirmed as dually approved or become dually approved to provide service coordination/care management for both EI and Health Home?

Response: The list of approved dually designated agencies can be found on the NYS Department of Health Homes for Children website: Approved Early Intervention Health Home Providers (ny.gov)

Additionally, information regarding how to become an approved NYS Early Intervention Service Provider can be found on the Information for Service Providers website.

Early Intervention providers must maintain an active agreement with the New York State Department of Health Early Intervention Program which is reissued every 5 years. This Central Directory is updated every month and only lists agencies who are actively approved. If a Health Home care management agency (CMA) wants to become approved by the Early Intervention Program, please email provider@health.ny.gov to request an agency application.

If an Early Intervention Program service coordination provider wants to become a Health Home care management agency (CMA), please reach out to your county Health Home Find A Health Home By County (ny.gov) regarding their process for becoming a contracted CMA (all potential CMAs are subject to contract agreements with a lead Health Home).

After an agency has a contract to be a Health Home CMA and approved application from the Early Intervention Program, a dual designation request form must be approved by your lead Health Home(s), and both the NYS Health Home Serving Children Program and the Early Intervention Program which can be requested through Heath Home program Email Health Homes | Survey Builder (ny.gov) or the Early Intervention Program provider@health.ny.gov).

12. Question: How does a dually designated agency withdraw from providing Health Home or Early Intervention services?

Response: If a provider wants to withdraw from the Health Home program they should contact their lead Health Home. The lead Health Home will notify the NYS Department of Health of any contracting relationship changes. If a provider wants to withdraw from the Early Intervention Program, they should notify the Early Intervention Program Provider Approval Unit at provider@health.ny.gov. Please note, that a plan will need to be made with the respective contacts should the agency currently serve children.

Questions should be directed to the Health Home program hhsc@health.ny.gov or the Early Intervention Program beipub@health.ny.gov.