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.
How do agencies identify if an adult client is HARP/HCBS eligible?
HARP/HCBS eligiblity information is available using ePaces.
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.
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
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.
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.
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.
If an individual is eligible for ACCES-VR, how can adult Behavioral Health Home and Community Based Services (BH HCBS) provide employment and education services?
The BH HCBS Provider Manual stipulates that Education and Employment services may be provided to the extent to which they are not available under a program funded by the IDEA or available for funding by ACCES-VR. BH HCBS services and ACCES-VR services can complement each other, and whenever appropriate, the Health Home Care Manager and provider should ensure coordination with the ACCES-VR Vocational Counselor. It is important that an individual be provided the opportunity to make an informed choice between services and providers. Further guidance is forthcoming.
Are adults who are actively using substances, who have a history of substance use, or who have a history of incarceration eligible for Adult BH HCBS 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.
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?
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."
Does the LPHA need to document a qualifying psychiatric and/or SUD diagnosis to make the LPHA recommendation for CORE Services?
No. Under the 1115 Demonstration Waiver, CORE Services are limited to HARP-eligible individuals and as such a diagnosis does not need to be confirmed or documented in the LPHA recommendation or elsewhere in the case record.
Who is eligible for CORE services?
Eligibility for CORE Services is based on three criteria: 1. The individual must be HARP Eligible, 2. The individual must be enrolled in a HARP or HIV-Special Needs Plan (SNP); and The services must be recommended by a Licensed Practitioner of the Healing Arts (LPHA).
How do we determine scope, intensity, duration, and frequency of services for CORE?
The CORE provider will conduct an intake and engage the individual through person-centered planning (PCP) to determine frequency, scope, intensity, and duration of recommended services to move the person towards their goal. The clinical supervisor can be a resource to staff in formulating the service plan. See the Operations Manual for additional information about the PCP process.
What happens if a person wants to do additional CORE Services after their initial referral and intake?
If the LPHA recommendation does not include the additional service(s), an updated LPHA recommendation is necessary. An intake & evaluation for the new service(s) must be done and the service added to their ISP. The MCO must be notified of the additional service(s) as well.
What are the allowable service combinations for CORE?
CORE Services may be provided in combination with a variety of BH HCBS and State Plan services, like PROS or Outpatient Clinic. For more information on specifical allowable service combinations, please refer to the allowable service combination charts in the Benefit and Billing Guidance (pgs. 13-14).
If the HARP eligible client is enrolled in FST under CORE can their children receive FST services as collaterals?
The only person receiving services is the HARP enrolled/eligible person. The role of the Collateral is to provide support in helping the HARP member achieve their goals. In some circumstances, the HARP member can also ask FST provider to provide psychoeducation. Ultimately the HARP member is the client, and they identify their family of choice (who do not have to be 21+).
Can a CORE Provider meet with an individual who is inpatient in the hospital to begin an intake? Does it make a difference if the hospitalization is for behavioral health or medical reasons?
Yes, it is appropriate to meet with an individual to begin intake if they are hospitalized for BH or medical reasons. This practice will support strong engagement through a warm handoff.
Will OPWDD HCBS waivered enrolled individuals be eligible for CORE Services?
OPWDD HCBS waiver enrolled individuals are not able to be enrolled in a HARP/HIVSNP and therefore cannot access CORE Services. OPWDD waiver enrollees have access to similar services. For more information about the OPWDD waiver services please visit https://opwdd.ny.gov/types-services