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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
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