The Social Care Network Operations Manual

The Social Care Network Operations Manual has been released. You can find the Social Care Network Operations Manual (last updated 8/9/24) and the CHCANYS Overview of the Manual, which includes an FAQ section at the end, available for download. Key points are summarized below, but please review the overview and manual for more detailed information.

Key Points for Health Centers:

• Reimbursement: Community health centers may contract with Social Care Networks (SCNs) and be reimbursed for screening, navigation, and enhanced services. Reimbursement will only be provided if the community health center has not already received payment from Medicaid or another third-party payer for those services. 
• Fee Schedule: The fee schedule is not included in the manual. Each SCN Lead Entity must submit a fee schedule, which will be approved by OHIP and CMS before being released. OHIP will publish a publicly available HRSN fee schedule, including billing codes, prior to service go-live.
• Screening Requirements: Screenings must utilize the AHC HRSN Screening Tool or another assessment instrument with identical LOINC coding for question-and-answer pairs. Modifications to the questions are not permitted. Other screening tools may be used if the questions and answers have the same LOINC codes; however, this is not recommended as it is easier to have the AHC Screening Tool uploaded to your EHR by your vendor. SCNs may also require the use of the AHC Screening Tool exclusively.
• Social Care Navigators: The state envisions that a majority of Social Care Navigators will be Community Health Workers (CHWs). CHWs will be paid based on a fee schedule in 30-minute increments for direct engagement with patients. Unrelated to the waiver, but the state is awaiting federal approval for community health centers to bill for CHW services (as long as these services are not related to a threshold visit).
• SCN Participation: Health centers can participate in multiple SCNs and are encouraged to join networks that cover the regions where their patients live, even if the center doesn’t have a physical clinic in those areas. A patient’s home address determines which SCN they will work with, not the location of the clinic where they receive care. Health centers should consider this when deciding which SCNs to partner with.

Last week, we reported that the state has awarded nine Social Care Networks. You can access the networks and information on how to join them here: Awarded Social Care Networks