How do adult BH Home and Community Based Services (HCBS) work for those between the ages of 18 and 21?
The adult BH HCBS services are only available to eligible adults ages 21 and over in HARPs or HIV SNPs.
The adult BH HCBS services are only available to eligible adults ages 21 and over in HARPs or HIV SNPs.
No, the designation process to provide HCBS services to children is a separate and distinct process from the Adult HCBS designation.
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.
Capacity will be managed at the State level. For more information, please view the HCBS Capacity Management Webinar and Children's HCBS Capacity Management Refresher Webinar.
Waiver capacity will remain the same upon the initial implementation. Capacity may be expanded beginning July 2019, based on global spending cap allowances.
The child and family has choice of services and service providers. Documentation of this choice must be demonstrated by the Health Home Care Manager or Independent Entity. It is a requirement that the care planning process is person-centered and family driven.
Yes. The Plan of Care is a fluid document, so for HCBS-eligible children, services can be added as needed based on an identified need and capacity.
It is the responsibility of the children's HCBS provider who is delivering the service to notify the Medicaid Managed Care Plan of the first appointment.
The HCBS Level of Need (LON) expansion is anticipated to roll-out after the 3-year level of care expansion. It will begin no earlier than July 2022.
FPSS is provided by someone with lived experience to help parents and caregivers by empowering them, helping them navigate systems and negotiate services that the child is engaged in. Caregiver/Family Supports and Services is provided by a person with a Bachelor's degree. Their role is to help the family negotiate systems with specialized expertise in schools, education, juvenile justice, etc. A family peer might provide Caregiver/Family Support Services as well if they meet the qualifications.
No, the parent/caregiver does not need to be present to bill for Community Self-Advocacy Training and Supports.
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.
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.
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.
The nurse and the Respite provider are fulfilling different needs of the child, if a child requires a nurse they would seek this service through the State Plan
Yes, additional guidance will be provided.
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.
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.
Staff members are required to complete Mandated Reporter training prior to delivering HCBS.
Training to be Completed within Six (6) Months of Children’s Waiver Implementation for Existing Staff or within Six (6) Months of Hire for New Staff.
For staff hired before April 1, 2019, the following training must be completed within six (6) months of the 1915(c) Children’s Waiver implementation on April 1, 2019. For staff hired on or after April 1, 2019, the following training must be completed within six (6) months of hire date. • Personal Safety/Safety in the Community • Strength Based Approaches • Suicide Prevention • Domestic Violence Signs and Basic Interventions • Trauma Informed Care
These trainings must be completed by staff providing all HCBS except Youth Peer Support and Training (YPST), Family Peer Support Services (FPSS), and Crisis Intervention (CI).
All training records of staff must be recorded and maintained for auditing purpose.
A child/family’s service plan and goals are developed by the HH Care Manager or the IE in conjunction with the family. The HH Care Manager or IE then works with the HCBS service provider to determine which components of the service would help the person best and define scope, duration and frequency of services which is reflected in that provider’s HCBS service plan.
Prior to October 1, 2019, HCBS will be billed Fee for Service (FFS), so the Medicaid Managed Care Plan is not involved. As of October 1, 2019, when HCBS transitions to Managed Care, then there must be communication between the care manager/IE and the Medicaid Managed Care Plan about ongoing authorization for children in a plan.
The child's HCBS service provider will make frequency, scope, and duration recommendations and report back to the HH Care Manager/IE so they can update the Plan of Care as appropriate.
The Home and Community Based Service provider will work with the child and family to identify the goals in order to develop the plan around frequency, scope, durations/ the activities they will be engaging in.
No, the state will not issue a template. Each Health Home may have their own template as long as it meets the HH and HCBS required elements (Health Home Plan of Care Policy #HH0008 )
Prevocational Employment provides services that are not directly related to a particular job, rather these are geared at developing skills and supporting the child finding a job. Supported Employment provides services to support the child while they perform in a work setting (after they have acquired a job).
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.
The Health Home Plan of Care (HHPC) is the document created by the Health Home Care Manager (HHCM) that lists the full array of services (medical, dental, behavioral, social, etc.) that a child is receiving. The HHPC describes, at a high level, what those services should look like including scope, frequency and duration. Each HCBS provider will identify goals and objectives of the specific service they provide. They will discern appropriate frequency, scope and duration. They will share this, in the form of a HCBS Service Plan, with HHCM for inclusion in the HHPC.
No, because services are billed through the child’s Medicaid number.
Designated Day Habilitation providers are also Certified OPWDD providers. Some activities will take place at the Day Habilitation facility while others may occur in the community based on the goals identified in the Child’s plan of care.
Yes, between April 1, 2019 and January 1, 2020 YPST and CI services can only be provided to children enrolled in the Children’s HCBS waiver.
January 1, 2020 YPST and CI will be live as part of CFTSS and will be accessible by all Medicaid eligible children that meet medical necessity criteria.
If the MMCP has the minimum information required for HCBS payment as per the remedial POC policy, the MMCP can pay the claim. Otherwise, the MMCP may pend the claim and work with the provider to obtain the missing information.
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.
The service limits apply for the calendar year.
The plan should make reasonable efforts to ascertain what services have been provided in the calendar year through review of the Plan of Care, discussion with the care manager, and any other information available, such as the State monthly FFS services report for the enrollee.
Plans are reminded that the limit may be exceeded if medically necessary. The MMCP’s medical director may determine when it is medically necessary for the yearly limit on AT/V-Mods/E-Mods to be exceeded.
Providers may routinely share the HCBS Service Plan with care managers, but MMCPs are not required to obtain the assessment tool/outcomes for children in receipt of HCBS. Note that HCBS are provided in accordance with the Children’s HCBS Manual, which does not mandate a specific assessment tool. When monitoring access to care, MMCPs should remain consistent with the Children’s HCBS Manual requirements.
MMCPs should generally follow the authorization process as provided in the training materials and the service authorization guidelines, and cover services in accordance with the Children’s Home and Community Based Services Provider Manual.
All of the following steps are required before an MMCP authorizes work to begin: identification of the need for an AT/V-Mod/E-Mod pursuant to a person centered plan; a physician’s order; a clinical justification/evaluation; a cost projection/scope of work document; and MMCP medical director approval for projects in excess of the annual limit.
However, MMCPs are NOT required to obtain bids, and may have alternate financial arrangements with vendors that include plan-specific requirements for description of work/cost proposals and invoicing/billing.▼ Expand to view more
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. The State will not enforce enrollment through auto assignment processes until after 1/1/20.
See more about MMCP exclusions and exemptions at: https://www.nymedicaidchoice.com/who-does-not-have-join-health-plan
The State is exploring ways to address provider capacity issues and also to make provider capacity information available for those making referrals to services. Where a provider is unavailable, there should be documentation of efforts made to locate a provider or to identify alternate services that may assist the family. The MMCP may also assist in accessing alternate services. HHCMs who cannot locate providers for HCBS or CFTSS should report the issue to the lead Health Home.
The MMCP must be notified of the first appointment. Upon receipt of the HCBS Authorization and Care Manager Notification Form, the MMCP may ask HCBS providers for additional information regarding the services being provided to the child/youth. The MMCP should be notified of any significant change. The contract between the MMCP and the Health Home or the MMCP and the provider may require additional reports to support oversight of the services delivered to enrollees and/or meet state reporting requirements.
Yes. The Plan of Care is a living document and should identify person centered goals of the child and family. Under the children's HCBS workflow, F/S/D may not be available at the time the plan of care is first shared with the MMCP. The provider’s request for authorization of services will provide this information to the MMCP and the Health Home Care Manager (HHCM).
The State is working with providers and MMCPs to improve provider access and availability. Where a provider is unavailable, there should be documentation of efforts made to locate a provider or to identify alternate services that may assist the family. The MMCP may also assist in accessing alternate services. HHCMs who cannot locate providers for children's HCBS or CFTSS should report the issue to the lead Health Home.
Yes. The POC for a child participating in the Children’s Waiver should be updated with the identified services, why the service(s) is needed with initial goals and a title of the service as well as the provider (if known). It is not necessary to immediately identify the specific providers prior to submitting the POC if the child/family has yet to choose a provider or if the referral has been made to an HCBS provider but the provider has yet to determine if they have availability to accept the referral.
POCs are to be submitted to the MMCP within 30 days from the HCBS Eligibility Determination regardless of whether the name of the HCBS provider is known to complete all fields. POCs can be updated as more information is known and gathered. The POC should indicate if a referral to provider(s) was made. HCBS providers should be specified in the POC once the HCBS provider is identified.
For children, the POC should be reviewed, at minimum: during the 6-month HH CANS-NY assessment; annually during the annual HCBS/LOC re-determination (if different time frame); and when there is a significant life event.
The POC should be updated, at minimum, annually and any time there is a change to the POC of services, providers and or needs of the member. When there is a change to the POC that is specific to services, providers and or needs of the member; the POC must be sent to the MMCP.
Examples of significant changes include admission to a higher level of care or being discharged from a higher level of care. Significant changes in a child’s functioning can include increase or decrease of symptoms, and/or a new diagnosis. Further information can be located on page 5 here.
No, the Referral for Home and Community Based Services (HCBS) to HCBS Provider form must be used. The form as a fillable PDF can be located here.
No, the Freedom of Choice (DOH 5276) does not accompany the POC referral form as the form can be completed during the referral process for HCBS or any time after the HCBS LOC has been completed and DOH Capacity Management Team has informed the Care Manager the member has received a HCBS slot.
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.
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.
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.