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Community First Choice Option Provider Relations Work Group Meets

The Department of Health (DOH) convened the second meeting of the Community First Choice Option (CFCO) Provider Relations Work Group via conference call on July 7, 2017. The CFCO Provider Relations Work Group is one of five work groups created by DOH to support implementation of the CFCO. CFCO provides enhanced federal Medicaid matching dollars to the state in exchange for making available an expanded array of home and community-based services to Medicaid beneficiaries. CFCO services in New York will be delivered primarily through managed care plans and will be incorporated into the Managed Long Term Care (MLTC) benefit package beginning in April 2018.

Certain CFCO services such as home modifications, moving assistance, and automobile modifications raise unique billing and credentialing issues. The Department presented a draft set of CFCO billing codes for discussion and indicated that it is considering the use of modifiers to identify the program with which the beneficiary is associated. These codes are part of an effort to align rate and procedure codes for all of the Department's waivers, fee-for-service benefits, and managed care benefits.

The Department also briefly presented some credentialing practices for social and environmental support services that it had received from MLTC and Fully Integrated Duals Advantage (FIDA) plans. It is continuing to gather best practices from plans and from the Nursing Home Transition and Diversion Waiver (NHTD) and Traumatic Brain Injury (TBI) Waiver programs. It will use the information collected to develop guidance for credentialing these services.

Finally, the meeting touched on contracting and network adequacy. The Department intends to issue contracting guidance and recognizes that some counties may not have sufficient providers. In those counties, plans may have to contract with intermediaries that will recruit and retain service providers.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124