Early Intervention

ANNOUNCEMENT

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

TO: Health Home Servicing Children, Early Intervention Providers, Early Intervention Officials, and Other Interested Parties:

The New York State (NYS) Department of Health (DOH) Health Home Serving Children’s (HHSC) Program in collaboration with the Bureau of Early Intervention, would like to announce that effective July 1, 2024, children who are eligible for Health Home and Early Intervention services may be enrolled in both programs and providers may submit claims for all services delivered, including case management.

Providers may use one of the following three options for service delivery:

1. Dually Designated Agency:

When a child/family want 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 apply.

2. Separate Health Home and Early Intervention Providers:

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 for comprehensive care management and an Early Intervention Ongoing Service Coordinator for early intervention service coordination activities. The Health Home Care Manager may bill the Health Home PMPM for meeting the Health Home core service requirements and the Early Intervention Ongoing Service Coordinator may bill for early intervention service coordination activities according to the service coordination billing requirements.

3. Sub-contracting:

Health Home care management providers currently in a subcontracting relationship for delivery of early intervention service coordination services can continue this relationship if desired; however, Health Home care management agencies cannot separately bill for the early intervention services delivered by the subcontractor. Accordingly, Health Home care management providers may want to consider whether subcontracting arrangements are still feasible.

Please direct Health Home questions to https://apps.health.ny.gov/pubpal/builder/email-health-homes and Early Intervention questions to the Bureau of Early Intervention at beipub@health.ny.gov.