Frequently Asked Questions

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Are adult Home and Community Based Services (HCBS) only made available for HARP eligible clients?

Yes, HCBS services are only available to clients that are enrolled in a HARP or an HIV SNP after they've undergone assessment and the assessment has indicated that they are eligible and for which services. For more information consult a recent workflow presentation

Source: HCBS Peer Services 7.14.15

Can homeless clients use the Crisis Respite Home and Community Based Service for adults?

If an individual is HARP eligible, yes, but note that Crisis Respite has usage caps outlined in the HCBS manual and MCTAC trainings.

Source: HCBS Crisis Respite 7.29.15

How do agencies identify if an adult client is HARP/HCBS eligible?

HARP/HCBS eligiblity information is available using ePaces.

Source: HCBS Peer Services 7.14.15

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

Who will determine if an adult is HARP eligible?

New York State determines who is HARP eligible. Individuals are eligible if they meet target risk criteria/risk factors or are identified by the service system or a service provider.

Target Criteria:
-Eligible for mainstream enrollment and Medicaid enrolled,
-21 and older,
-Serious Mental Illness/Substance Use Disorder diagnosis,
-Not dually eligible for Medicare,
-Not participating in OPWDD program

Source: Managed Care 101 Webinar 7.21.15

Are adults in HIV SNPs included in HARPS?

Individuals in HIV SNPs are eligible for all services associated with HARP/HCBS under same rules as HARP eligible individuals.

Source: Managed Care 101 Webinar 7.21.15

How will determinations be made regarding settings that are subject to Heightened Scrutiny? Are individuals who reside in Scattered-Site housing considered eligible to receive adult Home and Community Based Services (HCBS)?

The housing settings that currently qualify as HCBS settings include an individual’s own apartment, scattered-site Supported Housing units, or in a family home. BH HCBS designated providers are expected to sign and submit to OMH an BH HCBS Settings Attestation form, declaring site compliance with the BH HCBS settings rule. Therefore, it is the responsibility of the providers to ensure standards are met. Settings under Heightened Scrutiny will not be approved until organizations have submitted a Heightened Scrutiny Self-Survey. Additional details on the survey will be provided. Further guidance regarding HCBS settings compliance is forthcoming. 

Source: State Released HCBS Q&A March 2016

If an individual has previously failed in an education program, is he or she eligible to receive adult Education Support Services? Is there a minimum number of credits or classes an individual needs to pursue?

If the individual has been assessed as eligible for BH HCBS Education Support Services, has a goal that requires the service, and wants to receive the service, it should be included in the Plan of Care. Failing to complete an educational program in the past does not preclude an individual from receiving this service in the future. There is no minimum number of courses or classes in which an individual must be enrolled. Ongoing Supported Education is provided when an individual has been admitted to an educational or training program.

Source: State Released HCBS Q&A March 2016

Are adults who are actively using substances, who have a history of substance use, or who have a history of incarceration eligible for education or employment services?

If the individual has been assessed as eligible for Behavioral Health Home and Community Based Services (BH HCBS), has a goal that requires the service, and wants to receive the service(s), it should be included in the Plan of Care. Substance use and a history of incarceration should not be used an exclusionary criteria for these services. 

Source: State Released HCBS Q&A March 2016

Should Health Homes assess only HARP-enrolled individuals, or are we expected to assess all HARP-eligible individuals for Behavioral Health Home and Community Based Services (BH HCBS) eligibility?

Prior to conducting the adult BH HCBS assessments, Health Home Care Managers MUST verify HARP enrollment. See guidance at: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/community_mental_

health_assessments_billing_guidance.pdf

Source: State Released HCBS Q&A March 2016

Where on ePaces can providers find the adult HCBS codes?

On ePaces, providers should be looking at the section that lists the restriction and exception codes. Providers are looking for the "H codes."

Source: Plan of Care 10.9.15

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 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

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

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

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

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

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

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 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