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Ann Marie T. Sullivan, M.D., Commissioner
Governor Andrew M. Cuomo

Home and Community Based Services (HCBS) Waiver
Guidance Document
Division of Children and Families

600.2

Billing For Individualized Care Coordination (ICC)

The ICC is reimbursed at a monthly rate. ICC services are billed on the first of the month following the service month.

ICC services are provided from the effective date of HCBS Waiver eligibility up to the effective termination date.

In order to bill, ICC services must be clearly related to the Waiver child’s service plan goals and objectives. All qualifying ICC contacts must pertain to an ICC function as defined in section 300.4.

Service Delivery Minimums for ICC

Full Month – In order to bill Medicaid, the ICC must make a minimum of six (6) qualifying face–to–face contacts of a minimum of 15 minutes each in a calendar month. At least three (3) of those contacts must be with the child. The remaining contacts to make the minimum of six must be with collaterals identified in the child’s service plan. The child must be enrolled in the program for at least 21 consecutive days in the calendar month to bill for ICC services provided in that month.

Half Month – The ICC must make a minimum of three (3) qualifying face–to–face contacts, of a minimum of 15 minutes each, including at least two (2) with the child in the calendar month. The remaining contacts to make the minimum of three must be with collaterals identified in the child’s service plan. The child must be enrolled in the program for at least 11 consecutive days in the calendar month in order to bill for that month.

Two Half Months – If a child has been enrolled in the HCBS Waiver for at least 21 days in a calendar month under certain conditions the ICC billing can be made in half months. The Minimum face–to–face requirement for a whole month may be applied. For example, there are 2 contacts with the child and 1 contact with parent from May 1st to 15th, and one contact with the child and one contact with the teacher (a collateral) while in the hospital from May 16th to 28th, and then one more contact with the child and one with the parent from May 29th – 31st. In this case, there would be one regular half–month ICC and one–half month In–Patient ICC.

Full month (More than One Type of ICC Service but only one billable half–Month) – If a child has been enrolled in the HCBS Waiver for 21 days or more in a month, but there is only one billable half–month period with–in the calendar month, the remainder should be billed as a regular half–month. For example, child is enrolled on February 8, 2011 and is hospitalized February 15th returning home February 26th. In this case, there would be one half–month In–Patient ICC and one–half–month ICC provided that the minimum face–to–face contact requirements have been met.

Qualifying Face–to–Face Contacts

Note: Rules pertaining to the total number of bundled IIH or CR and ICC contacts allowed for billing in a day are found in 600.3.

Rules for ICC Start–Up Services

The Start Up period is the time period between the date the Waiver application is signed and the effective date of Waiver enrollment on the Notice of Decision–Acceptance form (NOD–A) which is issued by OMH's Operations Support Unit (OSU). It provides an enhanced ICC rate for the period before HCBS Waiver enrollment is determined. The rate includes payment for services that cannot be billed until the child is enrolled. ICC start up can only be claimed for a maximum of one month. Between the signing of the Application/Freedom of Choice and the OMH OSU issued enrollment date which is listed on the Notice of Decision–Acceptance form (NOD–A), billing can be for either one full month or one half month or for 2 consecutive half months, as long as the required number and types of ICC contacts have been made (see Chapter 600 Billing). The ICC Start–Up rate codes are used for billing the start–up services. No hourly services will be paid through EMedNY for the ICC Start–Up period.

The ICC agency will not be reimbursed for Start–Up periods for those children that sign a Waiver application but are not ultimately enrolled in the waiver. If a child completes the Start–Up period, but is not ultimately enrolled, Start–Up cannot be billed. Denials have been minimal and most often are due to hospitalizations or Medicaid ineligibility because of the child's asset/income or citizen status.

Rules for ICC Services Provided While the Child is in out of the Home Placement

Hospitalization (Psychiatric or Medical)

Jail or Detention

Residential Assessment Program or Substance Abuse Treatment Program

Residential Treatment Facility and Psychiatric Hospitalization During Start–Up

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.