Is there a cap for how many family members or collaterals the person may identify to receive adult Family Support Services?
No. The individual receiving this service is the one who decides which family members and other collaterals may be engaged in the service.
What are the requirements and expectations regarding supervision of peer support specialists/advocates for adults?
Per state issued guidance, supervision of peer support must be provided by a licensed behavioral health practitioner. The frequency of supervision should be determined as clinically appropriate.
If a provider were to use a certified peer from an existing program, would it affect the staffing plan of that program, e.g. a peer from a PROS program providing an adult Behavioral Health Home and Community Based Service (BH HCBS). Will peer time for the BH HCBS be subtracted from PROS staffing plan?
Yes. Sharing staff between your adult BH HCBS and other certified programs is allowed; however, the total time (FTE) that an employee spends on BH HCBS must be separated out on the CFR, and the PROS staffing plan must account for this.
For adult CPST what are the criteria for a “licensed professional,” and does a CASAC (Credentialed Alcoholism and Substance Abuse Counselor) meet these criteria?
CPST must be provided by "Professional Staff",” as defined in the BH HCBS Manual appendix. The manual qualifies that those licenses are issued via NYSED and are focused on the provision of direct services related to the treatment of mental illnesses and SUDs. The CASAC credential is a certificate issued by OASAS, and as such should not be included.
For adults, how is CPST different from outpatient clinic or ACT (Assertive Community Treatment)?
CPST is a Behavioral Health Home and Community Based Service (BH HCBS) available to individuals who are identified as having that need via the NYS Community Mental Health Assessment. It is a stand-alone service providing clinical mental health services to individuals in the community, at the intensity that best meets the individual’s needs. As opposed to outpatient clinic, CPST must be provided off-site, in the individual’s home or a community setting.
ACT is an evidence-based treatment approach targeting people who are resistant to traditional methods of
service delivery or for whom those approaches have not proven effective. There are specific treatment modalities employed, specific staff competencies and trainings proscribed; these are provided by closely monitored consistent teams specializing in a variety of disciplines and life areas, with a focus on ongoing monitoring and communication between all members via their daily Team Meeting. There is no provision in BH HCBS, or specifically CPST, for this intensity of service. The foundation of BH HCBS is that they are consumer-driven and recovery-oriented; they are not intended to address the intense engagement needs that ACT-appropriate consumers have.
Individuals receiving ACT services are not eligible for BH HCBS while they are receiving ACT services.
Often times adult peer support specialists provide support through phone, email, and texting. Can these activities be billed under adult Behavioral Health Home and Community Based Services (BH HCBS) Peer Support?
NYS recognizes that peer support specialists provide many valuable activities beyond face-to-face interventions. However, all BH HCBS must be provided face-to-face. Phone, e-mail, and texting would not be considered billable activities.
What are the requirements for Education Specialists for adult HCBS?
All Education Support Staff should have a minimum of two years working in behavioral health. Education Specialists should possess a Bachelor's degree and have two years of experience supporting individuals in pursuing education goals. A supervisor may be unlicensed and requires a minimum of a Bachelor's degree (preferably a Masters in Rehabilitation or a relevant field), a minimum of three years of relevant work experience, preferably as an education specialist.
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 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.
What would be the typical sequence(s) through which an adult would move between the various services in the Employment cluster?
Behavioral Health Home and Community Based Services (BH HCBS) Employment and Education services are not meant to be sequential. An individualized and person-centered approach should be used to identify the service(s) that are most appropriate to meet the individual’s needs.
Can adult CPST services and PSR services be provided concurrently, and if so, how will two different providers ensure that the combined 500-hour cap is not exceeded?
CPST and PSR may be provided concurrently. It will be important for providers to maintain contact with the Plan and Health Home Care Manager to ensure appropriate utilization management. Following an assessment, each provider will make recommendations regarding scope, duration, and frequency of the service. All BH HCBS are subject to utilization thresholds.
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.
Are adult Intensive Supported Employment and Ongoing Supported Employment subject to the same 250-hour cap that includes Pre-vocational Services and Transitional Employment Services?
Pre-Vocational Services and Transitional Employment are capped together at 250 hours per year. Intensive Supported Employment and Ongoing Supported Employment are each capped individually at 250 hours per year. An assessment by the provider will determine the appropriate frequency, scope, and duration of services. The provider(s) must work with the Plan and the Health Home Care Manager to ensure appropriate utilization management. In addition to the caps on the number of hours, providers should be aware that there are utilization thresholds listed in the Billing Manual that also apply.
How are adult Psychosocial Rehabilitation (PSR) and adult Habilitation different?
The adult BH HCBS Provider Manual provides definitions of each service. PSR services are designed to assist the individual with compensating for or eliminating functional deficits and interpersonal and/or environmental barriers associated with their behavioral health disorder. Habilitation services are designed to assist individuals in acquiring, retaining, and improving skills necessary to reside successfully in home and community-based settings.
What are the training and experience requirements for adult Family Support staff? Is there a credentialing process?
There is no certification or credentialing process specific to providers of Family Support and Training. This service may be provided by unlicensed staff who have at least a high school diploma or equivalent and 1-3 years of relevant experience working with individuals with behavioral health disorders. OMH-certified Peer Specialists and OASAS-certified Peer Advocates, CASACs, CASAC-T’s, and Certified Psychiatric Rehabilitation Practitioners (CPRPs) may also provide this service.
For adults, can Family Support & Training be offered to the individual alone to review and assess the plan, or does a family member need to be present in order to bill?
Family Support and Training is provided to family members at the individual's request. In order to bill for this service, a family member must be present.
Can you explain the group ratios for adult BH HCBS? The fees matrix has rates for groups of 2 or 3, but the HCBS Provider Manual indicates that you can have up to 16 individuals in a group.
Family Support and Training groups are limited to 2 or 3 families at a time, with no more than 16 individuals in any one group.
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.
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.
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.
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
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.
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).
Can Palliative Care: Bereavement Services continue beyond the death of a child?
No, because services are billed through the child’s Medicaid number.
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.
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.
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.