Funding Guidance for Health-Related Social Need (HRSN) Providers

• Guide also available in Portable Document Format (PDF)

Updated: September 2025

Memo: Reimbursement of HRSN service providers for services delivered via the SCN program

Context on the SCN program

Social Care Networks (SCNs) are regional networks designed to increase and strengthen the delivery of health-related social need (HRSN) services to Medicaid members. The 9 regional SCNs established by New York State deliver HSRN services through a network of diverse and culturally competent HRSN service providers, many of which are community-based organizations (CBOs).

Members are referred to HRSN services by Social Care Navigators, a specific role designated by the SCN Lead Entity (LE). Social Care Navigators determine Member eligibility for Enhanced HRSN Services (funded by NYHER 1115 Waiver), which include Care Management, Housing, Nutrition, and Transportation services. Social Care Navigators may be employed by the SCN Lead Entity itself or HRSN service providers within the network. HRSN service providers are required to be contracted with a SCN Lead Entity to be reimbursed for HRSN Screening, Navigation, and delivery of Enhanced HRSN services.

For more information on the SCN program or to reach out to the SCN Lead Entity in your region, visit: Social Care Initiatives webpage.

Roles

Social Care Navigator: May conduct Screenings, complete Eligibility Assessments, refer eligible Medicaid Managed Care (MMC) members to the appropriate HRSN service providers, and / or navigate Fee-For-Service (FFS) and other MMC members to existing federal, state, or local resources. In addition, navigators play a key role in confirming members are not receiving duplicative services before referring to HRSN service providers (e.g., collecting provider attestations or member documents for select services, confirming other services have been exhausted with MCOs, etc.).

HRSN service providers: HRSN service providers are primarily responsible for delivering HRSN services to Medicaid members and will be reimbursed if contracted with the SCN Lead Entity. Providers may accept any member referrals made through the SCN IT Platform and proceed with service delivery. In addition, they may conduct Screening and Navigation (and be reimbursed) if contracted to do so by a SCN Lead Entity. HRSN service providers may contract with approved subcontractors to support Screening and service delivery if the HRSN service provider is unable to provide the service itself.

Payment for services delivered by HRSN service providers contracted with a SCN Lead Entity

Reimbursement for services delivered as part of SCN program: HRSN service providers may bill for HRSN service delivery in accordance with the regional SCN HRSN fee schedule that is released by OHIP to the SCN Lead Entities.

Reimbursement for services delivered as part of SCN program: HRSN service providers may bill for HRSN service delivery in accordance with the regional SCN HRSN fee schedule that is released by OHIP to the SCN Lead Entities.

HRSN service providers must:

• Be contracted with the SCN Lead Entity
• Complete all required training as determined by the SCN Lead Entity
• Remain in Medicaid Good Standing according to Office of the Medicaid Inspector General website (if applicable)

Screenings and HRSN services are reimbursable if:

• The member was screened using the SCN IT Platform or a unique screening IT platform as approved by the SCN Lead Entity in contract or sent by a provider through SHIN-NY or a Qualified Entity. Screening should adhere to all requirements in the SCN Operations Manual (i.e. obtaining member consent, capturing an answer for all questions with either a response from the Member or indication that the question was not answered, use of AHC Screening tool)
• For Enhanced HRSN services¹, the member was referred to the HRSN service provider through the SCN referral pathway (e.g., by a Social Care Navigator who conducts an eligibility assessment using the SCN IT Platform or another platform able to send referral information to the SCN IT Platform)
• The member is eligible for Enhanced HRSN service as determined by the SCN program; for Enhanced HRSN services, eligibility requires members to be enrolled in Medicaid Managed Care; meet specific enhanced population, social risk and clinical criteria; and demonstrate unmet health-related social needs determined by the SCN program
• The Fee For service (FFS) member's HRSN screening demonstrates unmet HRSNs and the member is interested in receiving support for those needs, then the member should receive an HRSN Eligibility Assessment. For the SCN Program, the Medicaid FFS population will only be eligible for Navigation to existing local, state, and federal service. The member must not be receiving a duplicative HRSN Service from an alternate source (e.g., through federal, state, or local funding sources), as determined by the Social Care Navigator
• The HRSN services delivered are among the services approved by the SCN program.
• HRSN service provider follows any additional agreed upon terms as outlined in contracts with SCN Lead Entities

HRSN service providers within the SCN may be receiving funding from other sources to provide HRSN services to Medicaid members (e.g., via blk grants). Regardless of whether HRSN service providers receive additional funding to provide services to Medicaid members, they may bill and be reimbursed via NYHER for all members and services that meet the above criteria.

Overall, OHIP expects that services delivered by the SCN program will supplement, not supplant, services that are already received by members, including but not limited to those covered under existing state and federal programs, Medicaid home and community-based waivers, and In Lieu of Services (ILOS) provided by MCOs. HRSN service providers do not need to check for duplicative services, as SCN Social Care Navigators are responsible for doing so prior to making a referral. If a HRSN service provider receives a referral, they may accept the referral and proceed with service delivery.

For example, if a member is already receiving mold and pest remediation services through another state program such as Healthy Homes, they should not receive mold and pest remediation services from the SCN. In this case, the Social Care Navigator would not submit a referral (see Operations Manual Section 5.m Duplicative Services for a detailed view on programs and services that are considered potentially duplicative with HRSN services).

HRSN service providers must ensure that the funds administered are for the purpose of supplementing existing activities and never used to supplant funds for activities that were previously covered by other federal, state, or local funding. SCN reimbursement for HRSN service delivery is not considered duplicative if the service provided to the individual meets the criteria above. HRSN service providers with multiple funding streams should ensure they follow the requirements of each source of funding (e.g., reporting requirements).

Using multiple funding sources to provide services to a member: The 1115 waiver funding for HRSN services may not replace funding from other local, state, or federal programs. When applicable, this funding should be used to support the allowable HRSN services that the Member cannot access through other programs. New York State encourages HRSN service providers to use multiple funding sources to holistically address Member needs. Braided funding consists of multiple funding sources that are initially separate but brought together by an organization to meet the needs of a member, then pulled back apart to report to funders on how the money was spent. For example, a Medicaid member can receive housing navigation under a grant program and then be referred to the SCN to receive Community Transition Supports service paid by NYHER.

Services provided to a member that are outside the scope of the NYHER waiver amendment cannot be reimbursed regardless of whether a member is concurrently receiving SCN-referred services. Guidance may be adjusted over the duration of the SCN program to enable program impact and sustainability.

Summary: Process flows for joining a SCN and billing for services delivered

1. Can my organization join a SCN?

2. [For organizations that are part of SCNs] How does my organization know whether to bill NYHER for services delivered to a Medicaid Member?

___________________________________

^{1. Level 2 and specific enhanced services (e.g. Enhanced HRSN Care Management) are deemed "Enhanced HRSN services", while Screenings and Level 1 services are noted as just "HRSN services". 1}