Frequently Asked Questions

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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. 

Source: HCBS Employment/Education 7.21.15

If an agency provides services to both children and adults and has been approved for adult BH HCBS, do they receive automatic approval for the children's HCBS?

No, the designation process to provide HCBS services to children is a separate and distinct process from the Adult HCBS designation. 

Source: Transforming the Children's Medicaid System Webinar Part 2, 2.11.16

What is the role of C-YES (Independent Entity)?

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. 

Source: Children's HCBS Webinar Series March 2019

Is children's waiver capacity remaining the same?

Waiver capacity will remain the same upon the initial implementation. Capacity may be expanded beginning July 2019, based on global spending cap allowances. 

Source: Children's Aligned HCBS June 2018

What if the care manager and the family do not agree on what services are needed for the child?

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.

Source: Children's Aligned HCBS June 2018

Can children's home and community based services be added, as needed, to a Plan of Care?

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.

Source: Children's Aligned HCBS June 2018

Who is responsible for verifying the first service date for a child's Plan of Care?

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. 

Source: Children's Aligned HCBS June 2018

Is HCBS Level of Need (LON) still anticipated to roll out following the 3-year level of care expansion?

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.

Source: State April Roundtable 2019

How does children's HCBS Caregiver/Family Supports and Services differ from CFTSS Family Peer Support Services (FPSS)?

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.

Source: Children's HCBS Webinar Series March 2019

Does a caregiver or family member have to be present to bill for children's HCBS Community Self-Advocacy Training and Supports or can you work on the goals with just the enrolled youth?

No, the parent/caregiver does not need to be present to bill for Community Self-Advocacy Training and Supports.

Source: Children's HCBS Webinar Series March 2019

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.

Source: Children's HCBS Webinar Series March 2019

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.

Source: Children's HCBS Webinar Series March 2019

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.

Source: Children's HCBS Webinar Series March 2019

When it is necessary to support a child in HCBS Respite who has medical needs that require a nurse, how can both the Respite provider and the private duty nurse bill without running into a "double billing" problem?

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

Source: Children's HCBS Webinar Series March 2019

Will prior training be accepted to meet the children's HCBS pre-service training requirements?

Yes, additional guidance will be provided. 

Source: Children's HCBS Webinar Series March 2019

Can care managers refer children to Home and Community Based Services (HCBS) offered at the same agency, but by a different department?

Yes, if

  • the child/family is given choice 
  • the individual providing the service is not the same person as the care manager 
  • the service provider and the care manager have different supervisors

Source: Children's HCBS Webinar Series March 2019

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.

Source: Children's HCBS Webinar Series March 2019

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. 

Source: Children's HCBS Webinar Series March 2019

Are the children's HCBS pre-service training requirements expected to be completed by staff by 4/1? What happens if these are not completed by then?

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.

Source: Children's HCBS Webinar Series March 2019

Who is responsible for the child's HCBS service plan/goals, the HH Care Manager or the HCBS service provider?

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. 

Source: Children's HCBS Webinar Series March 2019

Please provide more information about how frequency, scope and duration of children's HCBS are determined.

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. 

 

 

Source: Children's HCBS Webinar Series March 2019

Will there be a standardized children's HCBS Plan of Care template released by the state that can/will be used across Medicaid Managed Care Plans for October 1, 2019?

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 )

Source: State Children's Waiver HCBS Workflow FAQ 2019

In Children's HCBS, what is the difference between Prevocational and Supported Employment?

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).

Source: Children's HCBS Webinar Series March 2019

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.

Source: Children's HCBS Webinar Series March 2019

What is the difference between the Health Home Plan of Care (HHPC) and the child's HCBS Service Plan?

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. 

Source: Children's HCBS Webinar Series March 2019

Can Palliative Care: Bereavement Services continue beyond the death of a child?

No, because services are billed through the child’s Medicaid number.

Source: Children's HCBS Webinar Series March 2019

Can children's HCBS Day Habilitation services be delivered in the community?

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.

Source: Children's HCBS Webinar Series March 2019

Are YPST and CI interim services in HCBS from April 1, 2019 until YPST and CI are implemented in CFTSS on January 1, 2020?

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.

Source: Children's HCBS Webinar Series March 2019

Are the elements that are listed for the Children's HCBS Plan of Care (POC) required to pay claims or should the Medicaid Managed Care Plan (MMCP) pass the claim through even if they do not have all of those elements?

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.

Source: State Released MMCP FAQ Sept 27, 2019

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.

Source: Children's HCBS Webinar Series March 2019

As part of Children's HCBS for E-Mod/V-Mod/Adaptive & Assistive Technology, does the $15,000 limit start as of the 10/1/19 transition to Managed Care?

The service limits apply for the calendar year.

Source: State Released MMCP FAQ Sept 27, 2019

For Children's HCBS modification and/or equipment services, do Medicaid Managed Care Plans need to ascertain whether a member has exceeded their yearly benefit for these services, and to do this they may work with the health home care manager, C-YES coordinator or LDSS?

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.

Source: State Released MMCP FAQ Sept 27, 2019

Should the Medicaid Managed Care Plan (MMCP) obtain the assessment outcome for children who are receiving Community Habilitation as part of children's HCBS?

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.

Source: State Released MMCP FAQ Sept 27, 2019

The State training document from June 6, 2019 describes the authorization process for AT, V-Mods and E-Mods (as part of Children's HCBS), but it does not specifically state that the bid process is not applicable to Medicaid Managed Care Plans (MMCPs). Can you confirm that that the bid process does not apply to MMCPs for the HCBS children’s carve-in effective 10/1/19? What is the MMCP’s role in the authorization process if child is in a Health Home?

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.

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Source: State Released MMCP FAQ Sept 27, 2019

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. 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

Source: State September Roundtable 2019

What steps should Care Management Agencies take when there are no designated Children's HCBS providers for Palliative Care or Respite services in a child’s MMCP network/service area?

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.

Source: State September Roundtable 2019

What is other documentation and/or reporting requirements that need to be shared with Medicaid Managed Care Plans (MMCPs), outside of the Plan of Care (POC) for children in receipt of HCBS?

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. 

Source: State Children's Waiver HCBS Workflow FAQ 2019

What is the process for Medicaid Managed Care Plans (MMCPs) to communicate with C-YES (independent entity) about Children's HCBS? How do MMCPs know who at C-YES to communicate with regarding Plan of Care (POC) updates?

C-YES and the MMCPs have developed communication pathways to share POCs and other information in a secure environment, similar to the processes used between Health Homes and MMCPs.

Source: State Children's Waiver HCBS Workflow FAQ 2019

Must Medicaid Managed Care Plans (MMCPs) accept a Plan of Care (POC) that lists a child’s needed HCBS, but does not include providers or frequency, scope, and duration (F/S/D) of services due to the absence/lack of designated providers within the child’s network/area?

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.

Source: State September Roundtable 2019

Should a Plan of Care (POC) be submitted to the Medicaid Managed Care Plan (MMCP), even if the Children's HCBS provider(s) has not yet been identified?

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.

Source: State Children's Waiver HCBS Workflow FAQ 2019

How often should the Plan of Care (POC) for a child in receipt of HCBS be updated and submitted to the Medicaid Managed Care Plan (MMCP)?

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.

Source: State Children's Waiver HCBS Workflow FAQ 2019

If the Children's HCBS provider has their own referral form can that be used instead of the State’s form?

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.

Source: State Children's Waiver HCBS Workflow FAQ 2019

Does the Freedom of Choice (DOH 5276) need to be completed with the Children's HCBS referral form?

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.

Source: State Children's Waiver HCBS Workflow FAQ 2019

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.

Source: Children's HCBS Capacity Management Refresher Webinar 9.25.19

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.

Source: Children's HCBS Capacity Management Refresher Webinar 9.25.19

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.

Source: Children's HCBS Capacity Management Refresher Webinar 9.25.19