Updates to Billing Requirements for Children's HCBS, CFTSS

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To:    Children's Home and Community Based Service (HCBS) Providers, Children and Family
          Treatment and Support Services (CFTSS) Providers,
          and Medicaid Managed Care Plans (MMCPs) including Mainstream Managed Care and
          HIV Special Needs Plans (HIV-SNPs)

Date: September 5, 2023

The Department of Health (DOH), in collaboration with the Office of Mental Health (OMH), Office of Addiction Services and Supports (OASAS), Office for People with Developmental Disabilities (OPWDD) and the Office of Children and Family Services (OCFS), is implementing a billing change that will allow claims for Children's Home and Community Based Services (HCBS) and Children and Family Treatment Support Services (CFTSS) to be paid based on the county in which services were provided, rather than a provider's corporate headquarters or central office address, effective December 1, 2023. This update is necessary to align with the Centers for Medicare and Medicaid Services (CMS) billing requirements, which dictate that services must be reimbursed based on the location of service delivery.

DOH will announce two webinars to be held regarding this change, one for providers and one for MMCPs:

The State has assigned a Federal Information Processing Standards (FIPS) code and a proxy locator code to each county in New York State. The applicable FIPS (if submitting electronically) or proxy locator (if submitting on paper) county code, indicating service location, must be included on all Children's HCBS, CFTSS claims submitted for dates of service on or after December 1, 2023. The county FIPS and proxy locator codes are as follows:

Federal Information Processing Standards (FIPS) County Code for Electronic Claims Proxy Locator Code for Paper Claims Rate Region
Code County Code County Rate Region
36001 Albany County 901 ALBANY Upstate
36003 Allegany County 902 ALLEGANY Upstate
36005 Bronx County 958 BRONX (The Bronx) Downstate
36007 Broome County 903 BROOME Upstate
36009 Cattaraugus County 904 CATTARAUGUS Upstate
36011 Cayuga County 905 CAYUGA Upstate
36013 Chautauqua County 906 CHAUTAUQUA Upstate
36015 Chemung County 907 CHEMUNG Upstate
36017 Chenango County 908 CHENANGO Upstate
36019 Clinton County 909 CLINTON Upstate
36021 Columbia County 910 COLUMBIA Upstate
36023 Cortland County 911 CORTLAND Upstate
36025 Delaware County 912 DELAWARE Upstate
36027 Dutchess County 913 DUTCHESS Downstate
36029 Erie County 914 ERIE Upstate
36031 Essex County 915 ESSEX Upstate
36033 Franklin County 916 FRANKLIN Upstate
36035 Fulton County 917 FULTON Upstate
36037 Genesee County 918 GENESEE Upstate
36039 Greene County 919 GREENE Upstate
36041 Hamilton County 920 HAMILTON Upstate
36043 Herkimer County 921 HERKIMER Upstate
36045 Jefferson County 922 JEFFERSON Upstate
36047 Kings County 959 KINGS (Brooklyn) Downstate
36049 Lewis County 923 LEWIS Upstate
36051 Livingston County 924 LIVINGSTON Upstate
36053 Madison County 925 MADISON Upstate
36055 Monroe County 926 MONROE Upstate
36057 Montgomery County 927 MONTGOMERY Upstate
36059 Nassau County 928 NASSAU Downstate
36061 New York County 960 NEW YORK (Manhattan) Downstate
36063 Niagara County 929 NIAGARA Upstate
36065 Oneida County 930 ONEIDA Upstate
36067 Onondaga County 931 ONONDAGA Upstate
36069 Ontario County 932 ONTARIO Upstate
36071 Orange County 933 ORANGE Downstate
36073 Orleans County 934 ORLEANS Upstate
36075 Oswego County 935 OSWEGO Upstate
36077 Otsego County 936 OTSEGO Upstate
36079 Putnam County 937 PUTNAM Downstate
36081 Queens County 961 QUEENS (Queens) Downstate
36083 Rensselaer County 938 RENSSELAER Upstate
36085 Richmond County 962 RICHMOND (Staten Island) Downstate
36087 Rockland County 939 ROCKLAND Downstate
36091 Saratoga County 941 SARATOGA Upstate
36093 Schenectady County 942 SCHENECTADY Upstate
36095 Schoharie County 943 SCHOHARIE Upstate
36097 Schuyler County 944 SCHUYLER Upstate
36099 Seneca County 945 SENECA Upstate
36089 St. Lawrence County 940 ST LAWRENCE Upstate
36101 Steuben County 946 STEUBEN Upstate
36103 Suffolk County 947 SUFFOLK Downstate
36105 Sullivan County 948 SULLIVAN Downstate
36107 Tioga County 949 TIOGA Upstate
36109 Tompkins County 950 TOMPKINS Upstate
36111 Ulster County 951 ULSTER Downstate
36113 Warren County 952 WARREN Upstate
36115 Washington County 953 WASHINGTON Upstate
36117 Wayne County 954 WAYNE Upstate
36119 Westchester County 955 WESTCHESTER Downstate
36121 Wyoming County 956 WYOMING Upstate
36123 Yates County 957 YATES Upstate

Submitting Electronic Claims

When submitting an electronic claim for Children's HCBS or CFTSS effective for claims with dates of service on or after December 1, 2023, providers must enter Value Code 85 plus the applicable FIPS code from the list above in the Value Code box of the claim. Providers must continue to include any other value code that is necessary to accurately report the claim (e.g., rate code) in this box.

Submitting Paper Claims

When submitting paper claims for Children's HCBS or CFTSS effective for claims with dates of service on or after December 1, 2023, providers must enter Value Code 61 plus the applicable proxy locator code from the list above in the Value Code box of the claim. Providers must continue to include any other value code that is necessary to accurately report the claim (e.g., rate code) in this box.

Systems Updates

The eMedNY system is being reconfigured to associate FIPS codes to the correct proxy locator codes to ensure the correct reimbursement amount is paid for each Fee for Service claim1. MMCPs must configure their systems to be able to accept the new billing changes from providers and pay claims correctly; and to be able to submit claims to FFS for any non-risk payments. MMCPS have 90 days from the date of this announcement to configure their systems to align with these requirements and begin paying claims based on the location of service delivery for dates of service on or after December 1, 2023. Providers will hold managed care claims for dates of service on or after December 1, 2023.

The HCBS Manual, CFTSS Manual, and MCTAC Billing Tool will be updated to reflect this change in billing guidance.

Questions about this update can be sent to: BH.Transition@health.ny.gov

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1. As a result of system reconfigurations, agencies may receive an auto-generated letter from eMedNY including information related to FIPS codes/proxy locator codes and their effective date. System effective dates may not align with program/policy effective dates. Providers must follow the guidance found in this announcement and any subsequent announcements released by DOH for accurate information on effective dates and policy implications. 1