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Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

Posted 5/2/2022 at 5:39 PM

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

Effective for dates of service on or after April 4, 2022, if a Medicaid Managed Care Plan (MMCP) receives an Home and Community-Based Services (HCBS) claim for a child whose enrollment in the Children’s Waiver cannot be verified by confirming a K1 Recipient Restriction/Exemption (RR/E) code on the child’s record, and if the MMCP has not received an Authorization and Care Manager Notification Form, the MMCP should deny the claim for lack of verification of Children’s Waiver eligibility, enrollment, and approved service. The MMCP may also deny the claim if the units billed are not supported by the frequency, scope, and duration documented on the Authorization and Care Manager Notification Form.

For more information, view these resources: