As of December 1, 2018, Foothold is now billing for HCBS eligibility assessments for members who are Health and Recovery Plan (HARP) eligible on behalf of the Health Homes and Care Management Agencies.
Please see the link below for an overview of the HCBS program: https://www.omh.ny.gov/omhweb/bho/hcbs-manual.html
HCBS Eligibility Assessments. To be able to bill for an eligibility assessment, the enrolled member must have an uploaded eligibility assessment in their chart under the “CORE & HCBS” tab.
An HCBS Eligibility Assessment claim will be generated once the enrolled member has an uploaded eligibility assessment and a BSQ completed for the same month the assessment was completed. This ensures that we are sending the HCBS EA claim to the correct payer.
Once the assessment and BSQ are completed, we will send the HCBS EA claim along with our normal claim submission process every Tuesday.
The HCBS EA claim has a date of service when the assessment was completed, a rate code of 7778 and a charge amount of $80. It will appear in the same place other Health Home claims are shown (e.g. the Claims section on the patient’s “Billing” tab - see below).
Note. A member can only have three HCBS claims submitted per calendar year. Once the member has more than three assessments uploaded into Foothold in a calendar year, we will not submit another claim on behalf of this member until the next calendar year.