The Independent Entity, referred to as C-YES will conduct HCBS Eligibility Determinations for children who are not yet enrolled in Medicaid and assist the child/family with Medicaid enrollment (if eligible).
Additionally, the Independent Entity will conduct HCBS Eligibility Determinations, annual re-determinations, and develop Plans of Care for children who opt out of Health Home Care Management.
The Independent Entity is not a provider of HCBS.
If a child is determined eligible for HCBS services by a Health Home Care Manager or C-YES, is the child eligible for the entire menu of HCBS services or does the care manager determine which specific services they are eligible for?
If a child is HCBS eligible, then they are eligible for all HCBS services but should only receive the services that are documented in the plan of care as relevant to the child/family’s goals.
Are children that are enrolled in Health Homes that are not transitioning from one of the Waivers, able to access children's HCBS?
Health Home eligible youth are not automatically eligible for HCBS. Children will need to meet target/risk/functional criteria to be determined eligible for HCBS.
Can you provide more detail about the children's HCBS Caregiver/Family Supports and Service limitation regarding special education/IDEA?
Special education and related services that are otherwise available to the individual through a local educational agency, under the provisions of the Individuals with Disabilities Education Act (IDEA) cannot be provided as part of HCBS.
Does the child’s care manager or the Independent Entity (C-YES) determine eligibility through the CANS?
If the child/family opt in to Health Home, then the care manager determines eligibility. If the child/family opt out of Health Home then C-YES determines their eligibility for HCBS.
Can you clarify the restrictions for children's HCBS Prevocational services? If a child has an IEP or is linked to ACCES-VR are they ineligible?
HCBS eligible children without an IEP or those who are not ACCES-VR eligible, can receive these services.
Children cannot get HCBS Prevocational or Supported Employment services if they should be getting them from school or ACCES-VR.
If there are components of Prevocational or Supported Employment that the child cannot receive through the school or thorough ACCES-VR they should get a letter from the school or ACCES-VR verifying that they cannot be provided or are being denied and then the child can get these services.
Does a child need an IDD/DD diagnosis in order to receive HCBS Community Habilitation (CH) or HCBS Day Habilitation (DH)?
A child does not need an I/DD diagnosis in order to receive Community Habilitation or Day Habilitation, however a child must have an identified developmental delay in order to receive either service. The service need must be described in the Child’s Plan of Care.
Day Habilitation addresses the assistance with acquisition, retention or improvement in self-help, socialization and adaptive skills.
Community Habilitation focuses on the child learning a skill rather than restoring a skill. Community Habilitation is not a rehabilitative service, meaning the provider is not trying to restore functioning.
Typically, Children who have an I/DD diagnosis benefit from Day Habilitation and/or Community Habilitation. Children who meet Level of Care through SED typically benefit from Psychosocial Rehabilitation (PSR) under CFTSS as the service is rehabilitative in nature. PSR DOES require the child to have a behavioral health diagnosis and a child with a developmental disability diagnosis without a co-occurring behavioral health condition is ineligible to receive this rehabilitative service.
Can Palliative Care: Bereavement Services continue beyond the death of a child?
No, because services are billed through the child’s Medicaid number.
Since populations included in the child-carve in for developmental disability population must meet one of the following: developmental disability and medically fragile or developmental disability in foster care and the OPWDD CAH waiver has ended/merged, how will children with just developmental disabilities receive HCBS?
Transitioning children will have access to the Children’s HCBS wavier. If a child/family prefers to utilize services in the OPWDD Comprehensive waiver they would need to meet that eligibility. A comparison of services available with the Children’s HCBS wavier and the OPWDD Comprehensive waiver be found here.
Must all children who are enrolled in Children’s HCBS also enroll in a Medicaid Managed Care Plan (MMCP)?
Children enrolled in the NYS Children’s Waiver (HCBS) who are not otherwise exempt or excluded from Medicaid Managed Care must enroll in an MMCP.
See more about MMCP exclusions and exemptions at: https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/nhtd-tbi/mmc_overview.htm
What is the time frame for children's HCBS codes to be reflected in eMedNY or ePACES once a waiver slot has been confirmed?
Once the capacity management team notifies the care manager that a slot has been assigned, a team member will start the code assignment process. Please allow 2-3 days for the process to be completed. Once entered, codes update almost immediately in eMedNY and in approximately 24 hours for ePACES. If for some reason this does not occur, please contact DOH capacity management.
Since a transitioned child (from the previous waiver) keeps their slot until they are discharged, do they still need an HCBS LOC completed in the UAS?
Yes, the federal government requires that the child be assessed annually (at minimum) to confirm they continue to meet the LOC Eligibility requirements to receive HCBS waiver services. This is not a new requirement.
What happens with the children who were transitioned into waiver services (from Care at Home, for example) because they are at risk for a higher level of care but who are using only care management, which used to be a waiver service on its own, and are not using HCBS?
Effective August 2019 via the 1115 Demonstration Waiver, CMS approved Health Home Care Management as a stand-alone service for Family of One Medicaid eligible children determined as HCBS/LOC eligible. The child must be HCBS/LOC eligible with an active LOC determination on file and have obtained a capacity slot. Please see the guidance here.