Home Care Uniform Billing Rate Codes

On Sept. 15th, LeadingAge New York met with the Department of Health (DOH), other home care and managed care associations on uniform billing codes for home care services provided under contract with managed care plans.

As previously reported, the final budget included a provision that requires the use of standard billing codes for claims submitted to Medicaid managed care plans for home and community-based services (HCBS), fiscal intermediaries for the Consumer Directed Personal Assistance Program (CDPAPs), and nursing homes. This provision was supported by LeadingAge NY.

The goal of this work group is to develop uniform home care rate codes. LeadingAge NY asked our home care members for codes that are currently in use and received from DOH the rate codes for three 1915 (c) waivers. This extensive spreadsheet has been shared with DOH and the managed care representatives.

There was a general consensus that the proposed set of codes could be further simplified and that full implementation of the new coding system by the mandated deadline of Jan. 1, 2016 may not be feasible.  DOH will be sending to managed care plans Chief Fiscal Officers (CFOs) information on establishing two possible sets of home care rates codes and ask for their response to the proposed codes. The group decided to concentrate on the home care and adult day health care codes at this time and address the the waiver services codes at a later date.

LeadingAge NY will continue to keep members posted on any developments.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 or, Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827.