Notification to Medicaid Managed Care Plans (MMCPs) regarding Step-down agency pass through rates for 29-I Health Facilities

• Notification also available in Portable Document Format (PDF)

To: Medicaid Managed Care Plans (MMCPs), including Mainstream Medicaid Managed Care and HIV Special Needs Plans

August 11, 2021

29-I Health Facilities that were previously unlicensed Voluntary Foster Care Agencies (VFCA) and were reimbursed a Medicaid rate at a higher dollar amount than the established standardized 29-I Core Per Diem rates will require distinct rate codes, for some or all facility types, for the MMCPs to claim the State for their pass-through payment as the 29I Health Facilities "step-down" to the standardized 29-I Core Per Diem rates over the four-year transition period. Each MMCP will need to configure their system with the rate codes in the table below for these 'step-down' agencies/facility types; associated rate dollar amounts can be found on the 29I Health Facility rate summaries posted here.

For all other 29-I Health Facilities/facility type combinations (that are not 'step down'), the MMCP will utilize the standard Core Per Diem rate codes at the same rates over the same four-year period as outlined in the 29-I Health Facility Billing guidance and the rate summaries posted on the Department of Health webpage here.

Table: Step Down 29-I VFCA Health Facility Core Per Diem Rate Codes
MMCP rate code to use for pass through payment	Rate Code description	29-I VFCA Health Facility Name	Facility Type
4535	JCCA Sp. Needs	JCCA FH Division	Special Needs
4536	JCCA Diagnostic	JCCA FH Division	Diagnostic
4537	Forestdale TH	Forestdale, Inc	Therapeutic
4538	CMS Maternity	Community Maternity Svcs Bfc	Maternity
4539	NY Foundling Maternity	New York Foundling Hospital	Maternity
4540	CV ABH	Childrens Village	ABH
4541	CMS ABH	Community Maternity Svcs Bfc	ABH
4542	Lincoln Hall Inst	Lincoln Hall	Inst
4543	CV SILP	Childrens Village	SILP
4544	CMS SILP	Community Maternity Svcs Bfc	SILP
4545	St Joseph SILP	St Josephs Villa Institution	SILP
4546	RTA Transition*	George Junior Republic Assoc	Raise the Age
		Lincoln Hall
		St Josephs Villa Institution
4547	Good Shepard TH	Good Shepherd Services	Therapeutic
4548	Hope for Youth TH	Hope for Youth Aiken	Therapeutic
4549	JCCA TH	JCCA FH Division	Therapeutic
4550	NY Foundling TH	New York Foundling Hospital	Therapeutic
4551	NAFI TH	North American Family Institute	Therapeutic
4552	St Chris Ottilie TH	St Christopher-Ottilie	Therapeutic
4553	Astor Hard to Place	Astor Home For Children	Hard/Place
4554	JCCA E Hard to place	JCCA Edenwald	Hard/Place
4555	JCCA FH Hard to place	JCCA FH Division	Hard/Place
4556	Good Shepard Hard to place	Good Shepherd Services	Hard/Place
4557	Green Chimney Hard to place	Green Chimneys Childrens Serv	Hard/Place
4558	St Chris Jen Hard to place	St Chris Jen Clrksn C C Ser	Hard/Place
4559	St Joseph Hard to place	St Josephs Villa Institution	Hard/Place
4560	Long island Hard to place	Long Island Adolescent	Hard/Place
4561	CV Hard to Place	Childrens Village	Hard/Place
4562	CMS hard to place	Community Maternity Svcs Bfc	Hard/Place
4563	St Chris Ottilie Hard to place	St Christopher-Ottilie	Hard/Place
4564	CV Raise the Age	Childrens Village	Raise the Age

*Note: rate code 4546 applies to George Junior Republic Assoc, Lincoln Hall, and St Joseph's Villa Institution, all three agencies will step-down at the same rate over the same four-year period, for Raise the Age.

Submit questions to: BH.Transistion@health.ny.gov