Filetype PDF | Posted on 17 Jan 2023 | 2 years ago
Authentication
digital resources
152x Filetype PDF File size 0.47 MB Source: www.health.ny.gov
GUIDE TO RESTRICTION EXCEPTION (RE) CODES AND HEALTH HOME SERVICES
RE CODE RE CODE DESCRIPTION COMPATIBLE WITH HEALTH POLICY NOTES
HOME SERVICES
RRP Podiatry
02 These are codes to restrict recipient to specific YES
(See notes)
podiatric providers.
RRP Dental
03 These are codes to restrict recipient to specific YES
dental providers. (See notes)
RRP Durable Medical Equipment
YES
04
These are codes to restrict recipient to specific (See notes)
durable medical equipment providers.
RRP Pharmacy
YES
05 These are codes to restrict recipient to specific (See notes)
pharmacy providers.
RRP Physician
06 YES
These are codes to restrict recipient to specific (See notes) Individuals can be in a Restricted Recipient Program (RRP) and enrolled in Health Home, but the Care
physicians.
RRP Clinic Manager should work with the recipient and contact their Managed Care Plan, if applicable, to ensure
08 These are codes to restrict recipient to specific YES compliance with any restrictions.
clinics. (See notes)
RRP In-Patient Hospital
YES
09 These are codes to restrict recipient to specific (See notes)
hospitals for inpatient services.
RRP Dental Clinic YES
10 These are codes to restrict recipient to specific (See notes)
dental clinics.
RRP Physician Group YES
11 These are codes to restrict recipient to specific (See notes)
physician groups.
RRP Physician Assistant/Nurse Practitioner
12 YES
These are codes to restrict recipient to specific (See notes)
PA/NP providers.
RRP Alternative Pharmacy
YES
13 These are codes to restrict recipient to specific (See notes)
alternative pharmacy providers.
4/29/2022 Page 1
GUIDE TO RESTRICTION EXCEPTION (RE) CODES AND HEALTH HOME SERVICES
RE CODE RE CODE DESCRIPTION COMPATIBLE WITH HEALTH POLICY NOTES
HOME SERVICES
Enrollee in Special Needs MC Plan (HIV SNP)
20 YES
(See notes)
This code is used to identify enrollees in Special
Needs Plans.
Like mainstream plans, recipients can be members of HIV SNP and enrolled in a Health Home program.
Enrollee in Special Needs MC Plan (HIV SNP)
21 YES
This code is used to identify enrollees in Special (See notes)
Needs Plans.
OMH Children's Waiver
Children that received services through this previous waiver have been transitioned to the new Children's
23 This code is used to identify recipients in the NO Waiver with Health Home Care Management or Care Management through an Independent Entity. The
OMH Home & Community Based Services (See notes) use of this RRE Code has ended effective 3/31/2019.
(HCBS) waiver for seriously emotionally
disturbed (SED) children.
OPWDD - Sub-Chapter A Exception
25 NO
This code is for individuals receiving OPWDD for
a limited period of time with no local shares.
LTHHCP - Long Term Home Health Care
Program (Lombardi Waiver)
Individuals receiving services through this waiver can either be enrolled in a Health Home or in the waiver,
30 Code used for individuals authorized for long NO but cannot be in both as each provides care management services. Care managers should work with
term care services who are eligible for nursing (See notes) individuals to determine which service best meets their needs.
home level of care and are residing in the
community. Services provided through a
certified LTHHCP provider.
Children receiving OMH TCM services are being transitioned and adults receiving HIV COBRA, OMH TCM and
Case Management Program; Medicaid Service OPWDD care management have transitioned into Health Homes. Individuals receiving EI TCM services will
Coordination/Case Management Program YES transition to Health Home enrollment at a later date. First Time Mothers/Newborns (NFP Targeted Case
35 (Medicaid OMH, COBRA, AI TCM, OPWDD) (See notes) Management) will not transition and can not be enrolled in the Health Home program while enrolled in
NFP. NFP Care Managers should refer individuals to the Health Home program upon disenrollment, if
Comprehensive case management program. appropriate .
4/29/2022 Page 2
GUIDE TO RESTRICTION EXCEPTION (RE) CODES AND HEALTH HOME SERVICES
RE CODE RE CODE DESCRIPTION COMPATIBLE WITH HEALTH POLICY NOTES
HOME SERVICES
ICF/DD Res
NO Individuals receiving services through this waiver can either be enrolled in a Health Home or in the waiver,
38 (See notes) but cannot be in both as each provides care management services. Care managers should work with
Recipient is a resident of an ICF-DD Facility. individuals to determine which service best meets their needs.
Aid Continuing
39 YES The care managers must work within the individuals established UT. Limitations on services may apply.
Recipient is subject to Utilization Threshold (UT) (See notes)
and exempt from copay.
HCBS at Home Non-Intensive Residential
Habilitation At this time OPWDD waiver participants cannot be in a Health Home and the waiver. If waiver participants wish
Recipient is in a HCBS Non-Intensive AHRH to NO to receive care management through a Health Home they must dis-enroll from the waiver. Health Home care
44 better serve consumers in their own homes and (See notes) managers and OPWDD Medicaid Service Coordinator (MSC) managers should work with individuals to
reduce demand for more costly residential determine whether the waiver or Health Homes can best meet their needs.
placement.
HCBS at Home Intensive Residential
Habilitation
NO
45 Recipient is in a HCBS IBS to better serve (See notes)
consumers in their own homes and reduce
demand for more costly residential placement. At this time OPWDD waiver participants cannot be in a Health Home and the waiver. If waiver participants wish
to receive care management through a Health Home they must dis-enroll from the waiver. Health Home care
managers and OPWDD Medicaid Service Coordinator (MSC) managers should work with individuals to
OPWDD Home & Community Based Services determine whether the waiver or Health Homes can best meet their needs.
Waiver - HCB (Pure Waiver) NO
46 (See notes)
Identifies a recipient in home & community
based services waiver program (HCBS).
4/29/2022 Page 3
GUIDE TO RESTRICTION EXCEPTION (RE) CODES AND HEALTH HOME SERVICES
RE CODE RE CODE DESCRIPTION COMPATIBLE WITH HEALTH POLICY NOTES
HOME SERVICES
OPWDD HCBS Community Habilitation Phase 2
NO
47 Identifies a recipient in home & community (See notes)
based services waiver supervised CR or
supervised IRA.
At this time OPWDD waiver participants cannot be in a Health Home and the waiver. If waiver participants wish
OPWDD HCBS Supportive IRAs and CRs to receive care management through a Health Home they must dis-enroll from the waiver. Health Home care
48 NO managers and OPWDD Medicaid Service Coordinator (MSC) managers should work with individuals to
Identifies a recipient in home & community (See notes) determine whether the waiver or Health Homes can best meet their needs.
based services waiver supportive IRA & CR.
OPWDD HCBS Supervised IRA
NO
49 Identifies a recipient in home & community (See notes)
based services waiver supervised IRA & CR.
MCC Pharmacy Individuals can be in a Managed Care Coordinator Program (MCCP) and enrolled in Health Home, but the care
55 An HR recipient enrolled in the MCCP and YES manager should work with the recipient and contact their Managed Care Plan to ensure compliance with any
receiving pharmacy services from the primary restrictions.
pharmacy.
MCC Physician
An HR recipient enrolled in the MCCP and Individuals can be in a Managed Care Coordinator Program (MCCP) and enrolled in Health Home, but the care
56 assigned to a primary physician or a preferred YES manager should work with the recipient and contact their Managed Care Plan to ensure compliance with any
provider. Non-emergent transportation must be restrictions.
ordered by a primary provider only. Ancillary
services (pharmacy, DME & lab) must be
ordered by primary or referred provider.
MCC Clinic
Individuals can be in a Managed Care Coordinator Program (MCCP) and enrolled in Health Home, but the care
An HR recipient enrolled in the MCCP and YES
58 assigned to a primary clinic where s/he must (See notes) manager should work with the recipient and contact their Managed Care Plan to ensure compliance with any
receive care or be referred for care. Ancillary restrictions.
services (pharmacy, DME & lab) must be
ordered by primary only.
4/29/2022 Page 4
no reviews yet
Please Login to review.
