Notification Regarding Enhanced Rates for Evidence Based Practices (EBPs) within Children and Family Treatment and Support Services (CFTSS)

  • Notice is also available in Portable Document Format (PDF)

To:   Medicaid Managed Care Plans (MMCPs), including Mainstream Managed Care and HIV
        Special Needs Plans and Children and Family Treatment Support Services (CFTSS)

Date: October 24, 2023

Effective November 1, 2023, New York State will implement EBP, pending State Plan Amendment (SPA) approval from Centers of Medicare and Medicaid Services (CMS). The State will authorize a selected number of qualified CFTSS’ providers to receive EBP training and bill for new EBP rates. NYS is committed to the promotion and support of Evidence Based Practices (EBPs), specific research supported psychotherapeutic interventions with demonstrated outcomes, within Children and Family Treatment and Supports (CFTSS).

CFTSS designated agencies that provide Other Licensed Practitioner (OLP), and Community Psychiatric Supports and Treatment (CPST) will be able to offer EBPs through an authorization process. Agencies must apply and receive authorization from the NYS EBP Review Team. Although individual practitioners or teams will be credentialed in an EBP, NYS will only issue authorization to agencies with OLP and CPST designation. Authorization will not be granted to individuals or groups. It is the responsibility of the EBP authorized agency to ensure they maintain fidelity to the EBP model. The State has identified Family Functional Therapy (FFT) and Parent-Child Interaction Therapy (PCIT) as allowable EBPs and intends to expand the list of EBPs and additional agencies in the future. All training and credentialing of the first cohort is anticipated in Fall 2023.

After providers receive EBP authorization from the State and begin the required training, will be allowed to bill the new EBP service rate codes. These new rate codes supplant existing rate codes for CPST or OLP when EBP services are provided. Providers submit the same type of rate code claim for individual sessions and family sessions. The rate and procedure codes numbers apply to both OLP family and individual sessions. The State will provide MMCPs with the list of authorized agencies for EBP (either through Exhibit 4 or via a separate list) to support MMCPs’ system configuration. EBPs in CFTSS will not require prior authorization from plans. MMCPs must begin accepting claims for EBPs starting November 1, 2023, and no later than 90 days from the date of this announcement. MMCPs will notify CFTSS providers within their network of when they can begin to submit claims for this service. MMCPs must accept claims for EBPs provided by CFTSS retroactive to November 1, 2023. MMCPs must provide guidance to CFTSS EBP providers on when/how to effectively submit claims for previously rendered EBPs no later than 90 days from this announcement. Note: There are no soft unit (i.e., annual, daily, dollar amount) limits for CFTSS. All determinations of scope, frequency and duration must be in accordance with medical necessity and an individualized treatment plan.

Service Description Rate Code Procedure Code Modifier Billing Unit Measure Unit Limit Pending Approval* Rates Upstate Pending Approval* Rates Downstate
Other Licensed Practitioner (OLP) Counseling Individual, EPB, FFT OTH LIC PRACT CNSL INDIVL: EBP, FFT Other Licensed Practitioner (OLP) Counseling Family, EPB, FFT OTH LIC PRACT CNSL INDIVL: EBP, FFT 7981 H0004 U1, UA 15 minutes N/A 77.02 86.37
Other Licensed Practitioner (OLP) Counseling Individual, EBP, PCIT OTH LIC PRACT CNSL INDIVL: EBP, PCIT Other Licensed Practitioner (OLP) Counseling Family, EBP, PCIT OTH LIC PRACT CNSL INDIVL: EBP, PCIT 7982 H0004 U1, UB 15 minutes N/A 81.86 91.80
Community Psychiatric Supports and Treatment (CPST) Service Professional, Individual and/or Family, EBP, FFT COMM PSYCH SUPP TRTMNT SRVC PROF: EBP, FFT 7983 H0036 U1, UA 15 minutes N/A 49.48 55.51

*Rates are draft pending approval of the State Plan Amendment by the Centers for Medicare and Medicaid Services (CMS). The State anticipates receiving CMS approval in early 2024 for the State Plan Amendment, which has a targeted effective date of November 1, 2023. MMCPs are expected to have their systems configured 90 days from the date of this notice.

The CFTSS provider guidance for the EBPs can be found here.

If you have any questions, please reach out to DOH at BH.Transition@health.ny.gov.