Home and Community Based Services (HCBS) Waiver
Division of Children and Families
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
- Face–to–face contacts are contacts the
has with the child or collaterals.
- Collateral persons are members of the client's family or household, or significant others, who regularly interact with the child and are directly affected by, or have the capacity of, affecting the child's condition. Collaterals must be identified and described in the child's service plan and must have a significant role in the child's development and well–being.
- Only one face–to–face contact in a day with the child can be considered qualifying.
- Only one face–to–face contact in a day with collateral can be considered qualifying.
- ICC telephone contacts are not qualifying face–to–face contacts.
- Each contact must be a minimum of 15 minutes.
- A Progress Note must be present for each contact.
- Another staff person or the ICC supervisor may substitute for the child's assigned ICC as long as he or she meets all of the ICC qualifications. This arrangement should be discussed with the family and the substitute should be familiar with the child's Service Plan in advance.
- Contacts with providers who can also bill Medicaid are not qualifying when those individuals are billing Medicaid at the same time for the contact. This includes but is not limited to staff members of outpatient clinics, Day Treatment programs, or any other mental health provider, medical providers billing Medicaid, and Day Treatment teachers. However, if a Medicaid Provider is identified in the child's Service Plan as a collateral and will not be billing Medicaid at the same time for the contact, then the ICC can bill for a minimum of a 15 minute contact.
- Some billing examples include:
- A teacher in a public school would not be billing Medicaid and so can be considered qualifying a collateral contact if they are identified in the child's Service Plan.
- An ICC may meet with the Waiver child's parent for 15 minutes prior to or following the parent meeting with a Medicaid service provider and this would be a billable collateral contact.
- An ICC or another Waiver service worker could have a qualifying collateral contact with a parent while the child is in Day Treatment.
- An ICC may meet with the Medicaid provider such as a clinic therapist. If the situation does not justify billing for the Medicaid provider (i.e. youth and family are not present), then the ICC could bill for the service if the Medicaid provider is identified in the child's Service Plan as a collateral.
It should be noted that billing for Day Treatment Programs occurs in half or full days and not by the individual contact. Therefore, billing for ICC contacts with Day Treatment providers should be carefully coordinated to ensure that duplication does not occur.
- An ICC may meet with the Medicaid provider such as a Day Treatment Provider. Clarification is necessary to determine how this Medicaid Provider will bill Medicaid. If the contact occurs on a day when the Day Treatment Provider cannot bill such as when the youth is out sick, absent or hospitalized and this Medicaid provider is identified in the child's Service Plan as a collateral then the ICC can bill for a minimum of a 15 minute contact.
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)
- The service delivery minimum outlined above applies while the child is an inpatient in a psychiatric or medical facility if the expectation is that the child will be discharged to the Waiver. The program may continue to provide and bill for ICC services and bundled Intensive In–Home Services while the child is hospitalized. The program may not seek reimbursement for Respite, Skill Building, Crisis Response, Family Support or unbundled IIH during an inpatient hospitalization. (See section 600.3 for explanation of bundled and unbundled services.) In order for ICC contacts with a child while hospitalized to qualify for reimbursement the child must return to the Waiver upon discharge from the hospital. If a child is hospitalized for 60 days over any 75 day period, the child must be dis–enrolled from the Waiver.
Jail or Detention
- A child may be in jail or detention for up to one month (up to 31 consecutive days) and remain in the Waiver, however, a child may be in jail or in detention for only part of a calendar month in which case, an agency may be able to bill. Appropriate Waiver billing can occur for the balance of the month the child is not in jail or detention. An agency may bill if during that month the child is home for the minimum of 11 days for half a month billing or 21 days for a full month billing and the minimum ICC face–to– face contacts have been made. If a child is discharged, it is expected that contact with the juvenile or criminal justice system will be pursued in order to provide necessary information on the youth's medical and psychiatric needs. Assistance should be provided to the family as part of the aftercare follow–up.
Residential Assessment Program or Substance Abuse Treatment Program
- Children may be placed in a residential assessment program or a substance abuse treatment program for up to 45 days and remain in the Waiver as long as the required ICC monthly or half monthly contacts are made and the child returns to home within 45 days. Other than ICC and bundled IIH, no other Waiver services may be billed.
Residential Treatment Facility and Psychiatric Hospitalization During Start–Up
- CMS has allowed ICC Start–Up services (see below) to begin 30–days prior to a child's discharge from a Residential Treatment Facility (RTF) or a psychiatric hospital. Although the ICC can begin the start–up activities while a child is hospitalized or in a Residential Treatment Facility, an enrollment date will not be issued until the required paperwork is submitted to OMH's Operations Support Unit and the child is discharged from the residential treatment setting or hospital (see chapter 500 for more information on enrollment and billing dates).
Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.