Situation Report | August 24, 2020
Current program manuals for both the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Medicaid waivers state that “providers must accumulate billable units until a whole hour is reached before billing for the service.”
To accommodate services provided through alternative means during the Public Health Emergency (PHE), effective March 1, 2020, providers may bill using partial units for the following services and will no longer be required to “accrue” time until one full unit is achieved.
- Independent Living Skills Training (ILST) NHTD rate code 9756; TBI rate code 9858
- Positive Behavioral Intervention and Supports (PBIS) NHTD rate code 9757; TBI rate code 9860
- Community Integration Counseling (CIC) NHTD rate code 9755; TBI rate code 9861
- Home and Community Support Services (HCSS) NHTD rate code 9795; TBI rate code 9879, 9880, 9881, 9882
- Structured Day Program NHTD rate code 9777; TBI rate code 9870
- Substance Abuse Program (TBI only) TBI rate code 9859
Providers should bill using 1/4 units (.25, .50, .75) but not less than a 1/4 (.25) unit.
During the PHE, services may be through face-to-face or alternative means. All service provision must continue to be documented according to service guidelines. All services provided through alternative means must be documented in the detailed plan explaining the alternative method of service delivery.
DOH anticipates that this billing accommodation will remain in place after the PHE.
Questions about this change should be sent to waivertransition@health.ny.gov.