Article 29-I Voluntary Foster Care Agency (VFCA) Well Care Visit Reminders
- Reminders also available in Portable Document Format (PDF)
To: Article 29-I VFCA Health Facilities and Medicaid Managed Care Plans including Mainstream Managed Care and HIV Special Needs Plans
Date: April 2, 2026
Well care visits are an essential part of health management for children and youth in foster care. Article 29-I VFCA Health Facilities (29-Is) with appropriate licensure and staffing are permitted to provide well care visits in alignment with requirements outlined in the Article 29-I VFCA Health Facilities License Guidelines and the 29-I Health Facility Billing Manual. For Health Effective Data Information Set (HEDIS) reporting purposes a Primary Care Provider is a physician or nonphysician (e.g., nurse practitioner, physician assistant, certified nurse midwives) who offers primary care medical services. This also includes general pediatricians, general or family practice physicians, geriatricians, general internal medicine physicians, and obstetricians/gynecologists (OB/GYN) as outlined in Appendix 3, HEDIS 2025 Volume 2 Technical Update. Medicaid Managed Care Plans (MMCPs) have a responsibility to ensure that their members receive appropriate medical care and services, including regular well care visits. New York State (the State) uses reported well care visit data to help monitor MMCP quality and performance. To assist with quality monitoring and data integrity, the State is offering the following reminders to 29-Is and MMCPs:
- Claims for services provided in a 29-I setting must include the 29-I agency National Provider Identifier (NPI) number. If the service is rendered by a practitioner eligible for Medicaid enrollment, their individual practitioner NPI number must also be included on the service claim as the Attending Provider (Box 76 of the U-04 form). Additional information about claiming for 29-I services can be found in the MCTAC Billing Tool.
- Practitioners rendering services in a 29-I setting are not required to individually contract or credential with the MMCP. The MMCP must accept a contract with the 29-I as sufficient to process all claims submitted by any practitioner operating within the facility. MMCPs cannot require practitioners to credential with the Plan as a Primary Care Physician (PCP) in order for their well care visit data to be considered. If needed, it is the responsibility of the MMCP to develop a system of obtaining supplemental data from 29-Is as a supplement to their standard HEDIS related submission. Plans are instructed to work with their HEDIS vendor and their auditor to determine the best mechanism for obtaining and submitting supplemental HEDIS data.
Questions about this reminder can be sent to BH.Transition@health.ny.gov.
