State communication: Foster Care Provider Education Update

As an Empire BlueCross BlueShield HealthPlus (Empire) network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCA).

Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located at: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.

The pharmacy benefit requirements for children/youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions and transitional fills for children/youth newly placed in foster care. ep Effective April 1, 2023, MMC members, including children/youth placed in foster care, had their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. However, Physician administered drugs, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies are still covered by Empire when billed as a medical or institutional claim. The Pharmacy Procedure Code manual can be found here: https://www.emedny.org/ProviderManuals/Pharmacy/PDFS/Pharmacy_Procedure_Codes.pdf

Upon placement into Foster Care, a child/youth is required to have an Initial Medical Assessment within the first 30 days of the child/youth’s placement. The child/youth may utilize any primary care physician (PCP) or qualified practitioner in the MMC network for the purposes of this Initial Medical Assessment.

For ongoing primary care visits, if there is a discrepancy with the assigned PCP on the MMC member ID card, the child/youth should not be turned away; instead, please immediately call Medicaid Provider Services at (800) 450-8753 to rectify this matter.