August 17, 2023

The CORE Benefit and Billing Guidance includes a list of allowable service combinations between CORE Services and other OASAS/OMH services and programs. This guidance currently allows Family Support and Training (FST) and Community Psychiatric Support and Treatment (CPST) to be delivered in combination with CCBHC services, with some exceptions described in the footnotes related to CPST. As a supplement to the CORE Benefit and Billing Guidance and as detailed below, this memo is intended to expand the CORE allowable service combinations to permit individuals receiving services from a CCBHC (sites included in the NYS CCBHC Demonstration) to access non-comparable CORE Psychosocial Rehabilitation (PSR) and CORE Empowerment Services – Peer Support Services as of November 15, 2023. This memo also directs MCOs to complete systems configurations by November 15, 2023 to reflect this update.

Guidance on Allowable Service Combinations for CORE and CCBHC

Allowable Service Combinations (Effective November 15, 2023)

Individuals may access services through both CORE and CCBHC (sites included in the NYS CCBHC Demonstration) in the same day or month if the individual is not receiving comparable services through both. The chart and accompanying footnotes in Appendix A of this memo reflect an update to the allowable service combinations in the CORE Benefit and Billing Guidance. Please carefully review the footnotes, which include specific guidance on what is and is not allowable.

Coordination Between MCOs and Providers

With this updated guidance, MCOs are responsible for identifying if an enrollee is accessing services through CCBHC and CORE PSR or CORE Peer Support during the CORE Service Initiation Notification process. MCOs may also discover service duplication during routine care management or claims review (CCBHC claims would be available via the Fee-For-Service (FFS) Claims Data Report shared by the State^[1]). In these scenarios, MCOs are responsible for resolving concerns related to duplication of services by following the process outlined in the CORE Benefit and Billing Guidance^[2]:

• Notify relevant providers as soon as possible,
• Initiate a person-centered discussion with the enrollee and facilitate informed choice, and
• Communicate the outcome and enrollee’s decision

MCOs are responsible for reimbursing CORE Service claims up to the date that the MCO notifies the CORE provider of the service duplication.

When the CCBHC becomes aware that an individual is also receiving CORE CPST, PSR, and/or Peer Support, a description of the individual’s involvement with the CORE provider and documentation of their preference to continue to receive CORE Services should be included in their treatment record. The CCBHC care coordination service may be used to help coordinate, support, and enhance communication and collaboration between providers. The CCBHC and CORE provider are responsible for ensuring compliance with State and federal privacy laws and for gathering PHI release forms when necessary. The CORE Services designated provider should document all coordination and collaboration in the case record.

Questions and Technical Assistance

• For OMH-Hosted CORE Services Designated Providers: CORE-Services@omh.ny.gov
• For CCBHC Demonstration Providers: CCBHC@omh.ny.gov
• For OASAS-Hosted CORE Services Designated Providers: PICM@oasas.ny.gov
• For MCOs: BHO@omh.ny.gov

Appendix A: CORE and CCBHC Allowable Service Combinations

(Effective November 15, 2023)

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¹ Please see pages 62-65 of the CCBHC MCO Operations Manual for information on the specific data elements included in the FFS Claims Data Report.

² See also: CORE FAQs.

³ Refers to CCBHC Demonstration providers. Please refer to the OMH CCBHC website for a list of NYS CCBHC Demonstration providers. This does not refer to CCBHC Expansion Grant Awardees, see the CORE Benefit and Billing Guidance for details.

⁴ Services comparable to CORE CPST are available through CCBHC. Enrollees may access non-duplicative services through CORE CPST and CCBHC in a single month for the following purposes:

• Access to a psychiatric prescriber (e.g., psychiatric assessment/ evaluation, medication management, health monitoring) if the CPST provider does not have a prescriber.
  • Receiving psychotherapy through CPST and CCBHC is duplicative. Medication management and supporting activities through the CCBHC are duplicative if the CPST provider has a prescriber on staff.
• Transition from CPST to clinic-based services (including at a CCBHC), allowing for a warm-handoff during the clinic pre-admission process (3 sessions). The CPST provider should maintain communication with the prescriber to ensure integrated treatment/care.

There has been no change to the policy on CORE CPST and CCBHC Demonstration Sites.

⁵ Services comparable to CORE PSR are available through CCBHC Psychosocial Rehabilitation Services. Individuals may access CORE PSR only if they are not receiving CCBHC Psychosocial Rehabilitation Services in the same time frame (i.e., if you are receiving CORE PSR, you should not engage in CCBHC Psychosocial Rehabilitation Services until or unless you are discharged from CORE).

⁶ Services comparable to CORE Empowerment Services – Peer Support are available through CCBHC Peer Support. Individuals may access CORE Peer Support only if they are not receiving CCBHC Peer Support Services in the same time frame (i.e., if you are receiving CORE Peer Support, you should not engage in CCBHC Peer Support Services until or unless you are discharged from CORE). The following exceptions also apply:

• Individuals may receive both CORE Peer Support and CCBHC pre-admission peer support services to support engagement in the CCBHC. When the individual is admitted, they need to be supported in making an informed choice between continuing CORE Peer Support or transitioning routine peer support services to the CCBHC.
• Individuals who receive CORE Peer Support may access CCBHC Peer Support Services in the event of a crisis. Refer to the CORE Operations Manual and the CCBHC Scope of Services Manual for Pre-Crisis and Crisis Support guidance.