Understanding

Care Management Requirements

and

Medicaid Status Impact

Regarding HCBS Eligible Children

October 31, 2019

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Agenda

Children’s Waiver Guidance Overview

1. HCBS Waiver Eligibility Service Requirements Guidance

2. Medicaid Eligibility Status Impact on HCBS Eligible Children Guidance

Questions

Appendix

October 2019

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Children’s Waiver Guidance Overview

October 2019

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Guidance OverviewPurpose: to provide more clarity and direction for Health Home, C-YES and Medicaid Managed Care Plan Care Managers regarding HCBS, the State has developed two new guidance documents. These documents are complimentary and should be referenced together.

• Intended to clarify eligibility determination

requirements

• Describes process for when a child/youth

in waiver experiences a significant life

event

• Outlines scenarios when a child/youth in

waiver is hospitalized or placed in an

HCBS restricted setting

• Clarifies monthly HCBS requirement,

accessibility, and matching services to

need

HCBS Waiver Eligibility

Service Requirements

• Intended to clarify Medicaid eligibility as it

relates to the approved 1115 waiver

• Explains how receipt of services is related

to waiver and Medicaid eligibility for

Family of One children

• Demonstrates when HHCM or HCBS are

required to obtain waiver eligibility

• Showcases process flows of matching

services to need and how this might impact Medicaid eligibility

Medicaid Status Impact on HCBS

Eligible Children

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Guidance OverviewBoth guidance documents can be found on the State’s website in the provider tools section

October 2019

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Guidance OverviewThe guidance documents are linked and also embedded into this presentation:

October 2019

HCBS Waiver Eligibility

Service Requirements

Medicaid Status Impact on

HCBS Eligible Children

The Children’s Waiver

HCBS Waiver Eligibility Service Requirements

This guidance is to provide clarification regarding Home and Community Based Services (HCBS) requirements for care managers to ensure HCBS eligible children/youth obtain the services as required for the child/youth to maintain Waiver eligible. The 1915(c) Children’s Waiver was implemented on April 1, 2019 and consolidated the six children’s HCBS waivers into one comprehensive waiver. Each waiver had nuance differences and different HCB Services. Additionally, with the consolidated Children’s Waiver now directly connected to Health Home Serving Children’s program, there are an increased number of care managers coordinating care for HCBS eligible children, when previously they had not done so. As such, the following is to clarify the requirements for services of HCBS eligible children within the Children’s Waiver. HCBS Level of Care (LOC) Determination: The new consolidated 1915(c) Children’s Waiver for HCBS requires an annual (365 days) HCBS Level of Care (LOC) Eligibility Re-determination to be completed for the child/youth to remain in the Waiver and continue receiving Waiver services. The Health Home care manager or C-YES staff are required to complete this eligibility determination prior to its annual expiration. The annual re-determination should begin two (2) months prior to the expiration of the current HCBS/LOC determination. It is the Health Home care manager’s or C-YES staff’s responsibility to know and understand the requirements and necessary paperwork needed to make an HCBS/LOC eligibility determination. For the target populations of Developmental Disability in Foster Care and Developmental Disability Medically Fragile, it is imperative that the Health Home care manager or C-YES staff work with the OPWDD DDROs to establish timely HCBS redeterminations. (See here for HCBS determination reconciliation timeline) If a child/youth experiences a significant life event, as defined as, significant impact/change to the child’s or caregiver’s functioning and their daily living situation, a new HCBS eligibility determination will be needed. With all new HCBS/LOC Eligibility Determinations, the annual determination timeline resets with the completion of a new assessment outcome. If a child/youth enrolled in the Children’s Waiver is hospitalized or placed in an HCBS restricted setting, then the child/youth can remain enrolled in the Children’s Waiver in such setting for up to ninety (90) days. During the ninety (90) days stay:

For children/youth in a Health Home, the MAPP segment would be “pended”, and no billing would occur while the child was in the restricted setting (Please refer to the HH Continuity of Care Policy)

The Health Home, C-YES or Medicaid Managed Care Plan (MMCP), if applicable, should notify all care team members of the child’s/youth’s placement.

The Health Home, C-YES or MMCP, if applicable, will stay in contact with the hospital or HCBS restricted setting and request to be notified thirty (30) days or as soon as possible, for shorter lengths of stay, prior to discharge.

The Children’s Waiver

Medicaid Eligibility Status Impact on HCBS Eligible Children This guidance is to provide clarification regarding Medicaid eligibility related to the Children’s Waiver and changes due to the approved 1115 Waiver. This guidance explains how the receipt of services are related to waiver and Medicaid eligibility for “Family of One” children. Specifically, the guidance explains when either Health Home Care Management or Home and Community Based Services (HCBS) are required for children to obtain eligibility for the Children’s Waiver and Medicaid eligibility. Together, the 1915(c) Children’s Waiver and the 1115 MRT waiver authorities provide Medicaid eligibility for children meeting the HCBS eligibility criteria under the Children’s Waiver. The 1915(c) Children’s Waiver was implemented on April 1, 2019 and consolidated six children’s HCBS waivers into one comprehensive waiver. The children’s 1115 MRT waiver amendment was approved on August 2, 2019 to allow “Family of One” to children meeting the 1915(c) Children’s Waiver criteria, who only receive Health Home Care Management services, to retain their Waiver eligibility status. This allows the child to have Medicaid eligibility determined under a “Family of One” budget if not otherwise eligible under community budgeting. The two authorities allow all children and youth eligible for the Waiver to have:

Greater ease of enrollment into Children’s Waiver;

Access to all HCBS (Home and Community Based Services) as needed;

Greater flexibility for HCBS to be delivered in natural environments for better outcomes;

Retain eligibility for Medicaid if “Family of One” and eligible for the Children’s Waiver. HCBS Care Management: All children/youth enrolled in the Children’s Waiver need care coordination services. Health Home comprehensive care management provides the care coordination service required under the Children’s Waiver. If a child/youth is eligible for the Children’s Waiver, they automatically receive Health Home care management and a separate Health Home eligibility determination is not needed. As Health Home is an optional benefit, a child/family can opt-out of Health Home services. For a child/youth who opts-out of Health Home services, their care coordination will be provided by the independent entity of Children and Youth Evaluation Services (C-YES). A child/youth who needs HCBS, but is not enrolled in Medicaid, will be referred to C-YES who will determine HCBS/LOC Eligibility and assist with establishing Medicaid eligibility. Once the child/youth is HCBS and Medicaid eligible, the child/family can choose who they would like to provide care coordination, Health Home or C-YES. “Family of One” Medicaid Eligibility: “Family of One” is a phrase used to describe a child that becomes eligible for Medicaid through the use of institutional eligibility rules. If a child is not otherwise eligible for Medicaid when counting parental income (and/or resources, if applicable), these rules allow for the child to have Medicaid eligibility determined as a “Family of One”, using only the child’s own income (and resources, if applicable). If a child/youth is not currently receiving Medicaid due to parental income (and/or resources, if applicable) and the child/youth is in need of waiver services, when the child/youth is found HCBS/LOC eligible and able to obtain a capacity slot, then based upon waiver eligibility, the child will have Medicaid eligibility determined as a “Family of One”. Note: There is a hierarchy that must be used in determining a child/youth’s Medicaid eligibility. This hierarchy requires that parental income information be included in the child’s Medicaid

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Care Manager:

HCBS Waiver Eligibility Service Requirements

October 2019

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Waiver BackgroundThe 1915(c) Children’s Waiver was implemented on April 1, 2019 and consolidated the six children’s Home and Community Based Services (HCBS) waivers into one comprehensive waiver

Each waiver had nuance and different HCB Services

The consolidated Children’s Waiver is now directly connected to Health Home Serving Children’s program, where there are:

- an increased number of care managers coordinating care

- an increased number of services available

- only HH care manager or C-YES conducted HCBS eligibility

October 2019

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• The HCBS Level of Care (LOC) Eligibility determination is valid for 1 year (365 days). In order for the child/youth to remain in the Children’s Waiver and continue receiving HCBS, an annual re-determination of eligibility is required

• An annual (365 days) active HCBS Level of Care (LOC) Eligibility re-determination is required to be completed for the child/youth to remain in the Children’s Waiver and continue receiving waiver services.

• The Health Home care manager or C-YES staff is required to complete this eligibility determination prior to its annual expiration. The annual re-determination should begin two (2) months prior to the expiration of the current HCBS/LOC determination.

It is the Health Home care manager’s or C-YES staff’s responsibility to know and understand the requirements and necessary paperwork needed to complete an

HCBS/LOC eligibility determination.

HCBS Waiver Eligibility Service Requirements Level of Care Determination

October 2019

Purpose: to clarify requirements for HCBS eligible children within the Children’s Waiver

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When an HCBS eligible child/youth who is receiving HCBS Waiver services enters a Hospital or HCBS Restricted Setting:

The child/youth can REMAIN enrolled in the Children’s Waiver while in a Restricted setting for up to 90 days

During the ninety (90) days stay:

1. For children/youth in a Health Home, the MAPP segment would be “pended” and Health Home care management could bill based upon the HH Continuity of Care Policy

2. For all children/youth, No HCBS billing would occur while the child was in the restricted setting

3. The Health Home, C-YES or Medicaid Managed Care Plan (MMCP), as applicable, should notify all care team members of the child’s/youth’s placement

4. The Health Home, C-YES or MMCP, as applicable, will stay in contact with the hospital or HCBS restricted setting and request to be notified thirty (30) days (or as soon as possible, for shorter lengths of stay) prior to discharge, to be part of discharge planning

HCBS Waiver Eligibility Service Requirements HCBS Restricted Settings

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Length of Stay – 90 days or shorter:

• The Health Home, C-YES or MMCP, as applicable, will be requested to be notified when the child/youth will be discharged

• Whenever possible, the Health Home or C-YES staff will conduct a new HCBS/LOC Eligibility Determination prior to discharge to ensure continuous waiver eligibility, will update the plan of care, as needed, and link the child/youth to service upon discharge

HCBS Waiver Eligibility Service Requirements HCBS Restricted Settings Length of Stay

If a child/youth leaves Waiver, a new HCBS/LOC Eligibility Determination can be conducted to determine

if the child/youth can be re-enrolled in the Waiver

Length of Stay – longer than 90 days:

Child/youth will be discharged from the Children’s

Waiver. Proper notification to the child/family of

the Notice of Decision will be followed as well as

notifying DOH Capacity Management. (Those

with “Family of One” Medicaid based upon waiver

eligibility and enrollment may lose their Medicaid).

The Health Home or C-YES staff will ask the

hospital or HCBS restricted setting to notify them

when the child/youth is being discharged, if the

child/youth will need and want HCBS upon discharge.

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HCBS Waiver Eligibility Service Requirements Necessary Monthly Waiver Service• Children/youth who meet HCBS/LOC eligibility (target, risk, and functional) criteria and

obtain a capacity slot, must be connected to and in receipt of HCBS on a monthly

basis

• The determination of services necessary must be supported by an assessment of

needs and strengths with the child/family and their identified care team to develop a

person-centered Plan of Care (POC)

• Based on the needs and priorities of the family, the care manager will link the family

with the appropriate services to best support their needs (including other Medicaid

needed services)

• The HCBS found necessary to maintain the child/youth in their home should be

supportive and appropriate for the child/youth’s needs

• The child/youth’s care record must reflect the needs and necessary services through

appropriate documentation

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HCBS Waiver Eligibility Service Requirements

October 2019

Monthly HCBS Required (Continued):

• If a child/youth has been determined eligible for HCBS and the child/family consents to

receive HCBS, then at least one HCBS must be received monthly to maintain eligibility

for the Children’s Waiver

• If the child/youth is not connected to an HCBS upon eligibility being determined or

misses monthly HCBS, then the Health Home care manager, C-YES or MMCP, as

applicable, must document efforts made to ensure access in the case record

• If there is a concern regarding the child/family’s interest in continuing HCBS and

issues occur regularly, then the Health Home, C-YES, or MMCP, as applicable, should

review quarterly (three months) HCBS with the child/family and care team to determine

if HCBS should be continued, terminated, or changed and/or if a referral to a different

provider/service is needed

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HCBS Waiver Eligibility Service Requirements Monthly HCBS Accessibility

October 2019

• Children/youth in Waiver who need at least one HCBS per month to safely live in their home and

community, must receive the HCBS needed and cannot be put onto waitlists for their HCBS

• It is the HHCM, C-YES, and MMCP’s, as appropriate, responsibility to ensure access to the

HCBS that meet the identified need in the POC and document efforts made to ensure access in

the case record

o Every effort must be made to find available HCBS and HCBS providers and the child must be

referred to another HCBS provider with capacity in their service area

o If the child/youth does not wish to change providers, they must receive at least one service

monthly to avoid losing their HCBS eligibility

• HHCM/C-YES should contact the MMCP if issues remain around finding HCBS and the Care

Management Agency must contact the lead HH for assistance; lead HHs will alert NYS DOH

and/or the MMCP

Regular access issues should be reviewed quarterly (every three months) by the HH, C-YES,

or MMCP to determine if HCBS should be continued, terminated, or changed

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Matching Services to Need and Addressing Capacity

Complex Service Needs Appropriate Services

Appropriate Service Review

Due to staggered timelines

and unique situations,

children/youth may be

receiving and or being

referred to multiple services

under the waiver and state

plan services

A person centered POC and

appropriate service review will

ensure children/youth are

receiving the services that

match their needs

Example: If all needs are met through

CFTSS or CFCO, the child/youth should

be disenrolled from the Children’s Waiver

Person-CenteredPOC

1. Ensure children/youth are matched to services based upon need and that are accessible

2. Disenroll children/youth who are not wanting, needing or utilizing services

3. Making services available to other children/youth who are waiting

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Medicaid Eligibility Status Impact on HCBS Eligible Children

October 2019

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The Children’s Waivers and Medicaid Eligibility

October 2019

1915(C) Children’s

Waiver

1115 MRT Waiver

Together, these waivers provide

Medicaid eligibility for children meeting

the HCBS eligibility under the

Children’s Waiver, allowing for:

• Greater ease of enrollment into

Children’s Waiver

• Access to all HCBS (Home and

Community Based Services) as

needed

• Greater flexibility for HCBS to be

delivered in natural environments

for better outcomes

• Retain eligibility for Medicaid if

“Family of One” and eligible for the

Children’s Waiver

The Children’s Waiver

consolidated the six

children’s HCBS waivers

The 1115 MRT waiver

allowed for “Family of One”

budgeting to children

meeting 1915(c) waiver

criteria

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Purpose: How Medicaid Eligibility Interacts with HCBS Eligible Children/Youth’s HCBS Requirements

• All children/youth enrolled in the Children’s Waiver need care coordination services

• Health Home comprehensive care management provides the care coordination service required under the Children’s Waiver

• If a child/youth is eligible for the Children’s Waiver first, they automatically receive Health Home care management and a separate Health Home eligibility determination is not needed

• As Health Home is an optional benefit, a child/family can opt-out of Health Home services

o For a child/youth who opts-out of Health Home services:

• If in FFS Medicaid, their care coordination will be provided by the independent entity of Children and Youth Evaluation Services (C-YES)

• if in enrolled in MMCP, their care coordination will be provided by the MMCP care manager

• A child/youth who needs HCBS but is not enrolled in Medicaid, will be referred to C-YES who will determine HCBS/LOC Eligibility and assist with establishing Medicaid eligibility

Medicaid Eligibility Status Impact on HCBS

Person-Centered Practice: The child/youth/family has choice who provides care coordination and their services.

Therefore, once the child/youth is HCBS and Medicaid eligible, the child/family can choose who they would like to provide

care coordination, Health Home or C-YES

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• Family of One: describes a child that becomes eligible for Medicaid through the use of institutional eligibility rules due to HCBS eligibility and enrollment

• If a child is not otherwise eligible for Medicaid when counting parental income (and/or resources, if applicable), these rules allow for the child to have Medicaid eligibility determined as a “Family of One”, using only the child’s own income (and resources, if applicable)

• If a child/youth is not currently receiving Medicaid due to parental income (and/or resources, if applicable) and the child/youth is in need of waiver services, when the child/youth is found HCBS/LOC eligible and able to obtain a capacity slot, then based upon waiver eligibility, the child will have Medicaid eligibility determined as a “Family of One”

• “Family of One” children/youth Waiver eligible and enrolled will have a KK code on their Emedy / EPaces file

There is no need for the Health Homes, CYES, or MMCP care managers to send anything to the Local Department of Social Services (LDSS) during annual HCBS re-certification as was done in previous waivers. See Administrative Directive to the LDSS

Medicaid Eligibility Status Impact on HCBS Family of One Medicaid Eligibility

October 2019

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Family of One Medicaid Eligibility (Continued):

There is a hierarchy that must be used in determining a child/youth’s Medicaid eligibility

Medicaid Eligibility Status Impact on HCBS

October 2019

Parental income information included in the child’s Medicaid application, even if the income is not ultimately used under a “Family of One” budget

If the child is in a medically fragile diagnostic group or certified disabled, parental resource information and any income of non-waiver siblings under age 18 will also need to be included on the Medicaid application

As part of the Medicaid eligibility determination, children/youth in a medically fragile diagnostic group will have a disability determination made by the State Disability Review Team, if disability status has not already been established by the Social Security Administration

Pending the disability determination, Medicaid coverage will be authorized for such children under an ADC-related “Family of One” budget, but the child/family will be required to comply with the disability determination

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Reminder:

The HCBS Eligibility Determination for the Target Population of Medically Fragile requires one of the following: Current SSI Certification, or DOH-5144 disability certificate, or Forms: DOH 5151, DOH 5152 and DOH 5153 completed by appropriate professionals and caregivers to

be reviewed and approved by an LPHA

If the Health Home or C-YES care manager completes the three forms of DOH 5151, 5152, and 5153, this can assist in HCBS eligibility. These forms are kept in the child/youth’s care record as supportive documentation of HCBS eligibility.

The LDSS will request from the family, documents to assist with the Disability Determination and the care managers can share the three documents to assist the family and the LDSS to gather the paperwork necessary for the Disability Determination.

The LDSS can determine the child/youth is “Family of One” while awaiting the Disability Determination under an ADC-related “Family of One” budget. The LDSS will ensure the necessary paperwork goes to the NYS DOH. Once Disability is determined, the certificate will be sent to the LDSS and a letter with the disability determination and eligible dates will be sent to the family. A copy of this letter is sufficient for the care manager’s annual HCBS re-certification documentation the following years instead of the three forms.

Medicaid Eligibility Status Impact on HCBS Disability Determination

October 2019

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Family of One Medicaid Eligibility (Continued):

• Any “Family of One” child/youth can also receive other Medicaid services (i.e. State Plan services) such as Private Duty Nursing, Children and Family Treatment and Support Services (CFTSS)

• Once a child/youth with “Family of One” Medicaid is no longer eligible for the Children’s Waiver and/or doesn’t receive HCBS or Health Home care management, they may lose their Medicaid eligibilityaltogether or they may have to meet a large spenddown each month in order to access Medicaid services*

• Community Eligible Medicaid is when a child/youth is determined eligible for Medicaid based on a budget that includes family income (and resources when applicable) in the budget calculation (MAGI, ADC-related, or SSI-related community budget) and is not tied to Children’s Waiver eligibility. However, Community Eligible children/youth who are HCBS eligible and enrolled must also be in receipt of one HCBS each month

Medicaid Eligibility Status Impact on HCBS

October 2019

Once a child/youth obtains Medicaid under “Family of One” they must be continually enrolled in

the Waiver and receiving HCBS or Health Home care management services to continue their

“Family of One” eligibility for the Medicaid.

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For all children/youth whether Community Eligible or “Family of One” Medicaid, a determination of services necessary must be supported by an assessment of needs and strengths with the child/family and their identified care team as developed in the person-centered plan of care (POC)

HCBS found necessary to maintain the child/youth in their home should be supportive and appropriate for the child/youth’s needs

The child/youth’s care record must reflect the needs and necessary services through appropriate documentation

Medicaid Eligibility Status Impact on HCBS Plan of Care Connected to Assessed Needs

October 2019

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• If an HCBS/LOC eligible child/youth has no assessed need for an HCB Service, and is only eligible for Medicaid under a “Family of One” budget, then similar to the previous HCBS Waivers, if the child/youth receives Health Home Care Management in order to be maintained in the home, the child/youth qualifies for the Children’s Waiver

• Health Home care management may be the sole service for a “Family of One” child/youth to continue waiver eligibility and have access to other needed Medicaid services. In these cases, only Health Home comprehensive care management with monthly face-to-face monitoring, regardless of acuity level, is allowable; C-YES care coordination will not meet this requirement. This restriction must be explained to the child/family

• In contrast, a community Medicaid eligible child must receive an HCBS waiver service monthly to continue waiver eligibility.

Medicaid Eligibility Status Impact on HCBS HCB Service vs. Health Home Care Management

October 2019

“Family of One” children/youth have the same monthly HCBS requirements to be enrolled in waiver

Health Home Care Management Services only, can count as the required monthly HCBS for

children/youth who have “Family of One” Medicaid

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Obtaining Medicaid Eligibility

October 2019

Family of One child/youth (KK code) meets Children's Waiver

eligibility, has slot, and Medicaid eligibility for

services

Child/youth receives only Health Home services at least

monthly

Child/youth receives HCBS at least once

monthly

Child/youth chooses HHCM

Child/youth chooses C-YES care

coordination (with MMCP CM if applicable)

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Process regarding children/youth that longer meet the Children’s Waiver criteria or need the HCBS/Health Home Services

Disenrollment from the Waiver

October 2019

Child/youth no longer meets Children's Waiver eligibility (target, risk, and functional criteria) or has no need for

HCBS or Health Home

Child/youth is community eligible Medicaid (not Family

of One & no KK code)

Child/youth is disenrolled from waiver authorities but retains Medicaid eligibility

for other services

Child/youth is Family of One (KK code)

Child/youth is disenrolled from waiver and Medicaid

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• State Plan Services such as Children and Family Treatment and Support Services (CFTSS) or Community First Choice Options (CFCO) must be utilized prior to HCBS Waiver services, if they can meet the child/youth’s needs.

• If State Plan or CFCO services alone meet the needs of the child/youth, then the child/youth should not be enrolled in the Children's Waiver unless the child/youth is only eligible for Medicaid under “Family of One”

• A “Family of One” child/youth who meets the Children’s Waiver eligibility criteria and receives HCBS and/or Health Home Care Management, can access other State Plan services such as Private Duty Nursing, and will continue to meet waiver and Medicaid eligibility requirements

Matching Services to Need and Addressing Capacity

October 2019

1. Ensure children/youth are matched to services based upon need and that are accessible

2. Disenroll children/youth who are not wanting, needing or utilizing services

3. Making services available to other children/youth who are waiting

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Disenrollment from Waiver if Child/Youth Does not Receive Monthly HCBS but Continues to meet Children’s Waiver Criteria

Disenrollment Process from Waiver

October 2019

Child/youth meets Children's Waiver eligibility (target, risk, and level of

care), has a waiver slot, may or may not be certified

disabled

Child/youth does not receive monthly

HCBS

Child/youth is not Family of One (no

KK code)

Child/youth is disenrolled from

waiver authorities but retains

Medicaid eligibility for other services

Child/youth is Family of One (KK code) and receives

Health Home services

Child/youth retains eligibility through

waivers

Child/youth is Family of One (KK code) and does not

receive Health Home

Child/youth is disenrolled from

waivers and Medicaid

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October 2019

RR/E code RE code Description

K1 HCBS LOC

K2 HCBS LON (will not be in use < 2021)

K3 HCBS Serious Emotional Disturbance (SED)

K4 HCBS Medically Fragile (MF)

K5 HCBS Developmentally Disabled (DD)

K6 HCBS Developmentally Disabled and Medically Fragile (DD & MF)

K7 HCBS Complex Trauma (will not be in use < 2021 with LON)

K8 Voluntary Foster Care Agency

K9 Foster Care

KK Family of One

K Codes RR/E for New Children’s Waiver

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October 2019

1915c RR/E

Codes

1915c RR/E Code Description K Code RR/E

Series

K Code RR/E Series Description

23 OMH SED HCBS Waiver K1 HCBS LOC

K3 HCBS SED

62 DOH Care at Home MF HCBS Waiver K1 HCBS LOC

K4 HCBS MF

63 DOH Care at Home MF HCBS Waiver K1 HCBS LOC

K4 HCBS MF

65 OPWDD Care at Home MF HCBS Waiver K1 HCBS LOC

K6 HCBS DD/MF

72 OCFS B2H SED HCBS Waiver K1 HCBS LOC

K9 Foster Care

K3 HCBS SED

73 OCFS B2H DD HCBS Waiver K1 HCBS LOC

K9 Foster Care

K5 HCBS DD Foster Care

74 OCFS B2H MF HCBS Waiver K1 HCBS LOC

K9 Foster Care

K4 HCBS MF

Current 1915c RR/E Waiver Comparison to K Codes

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October 2019

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Appendix

October 2019

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Department of Health Complaints• Enrollees and providers may file a complaint regarding managed care plans to DOH

• 1-800-206-8125

• managedcarecomplaint@health.ny.gov

• When filing:

• Identify plan and enrollee

• Provide all documents from/to plan

• Medical record not necessary

• Issues not within DOH jurisdiction may be referred

• DOH is unable to arbitrate or resolve contractual disputes in the absence of a specific governing law

• File Prompt Pay complaints with Department of Financial Services: https://www.dfs.ny.gov/insurance/provlhow.htm

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October 2019

• Referral Form Instructions• The Children and Youth Evaluation Service (C-YES) accepts referrals from individuals and providers

including a parent, wider family member, doctor, therapist, school guidance counselor, CBOs and others:

• Individuals and families should call C-YES so that we can send you a Referral Form and a pre-paid return envelope in the mail right away! You can mail back the form in the envelope at no cost to you. Call C-YES at 1-833-333-CYES (1-833-333-2937). TTY: 1-888-329-1541

• Providers and Organizations with secure email protocols can download the Referral Form below. Return the form to: CYESREFERRAL@MAXIMUS.COM. Be sure to include the child/youth's name and contact information!

• C-YES Referral Form

Questions? Call 1-833-333-CYES (1-833-333-2937). TTY: 1-888-329-1541.

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October 2019

Resources and Questions

• HHCMs and HH CMAs should first talk with their Lead Health Home regarding questions and issues they may have

• Questions, comments or feedback on Health Homes Serving Children to: hhsc@health.ny.govor contact the Health Home Program at the Department of Health at 518.473.5569

• Specific Questions/Comments regarding Transition services BH.Transition@health.ny.gov

• Subscribe to the HH Listserv

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/listserv.htm

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October 2019

UAS-NY Support Desk

uasny@health.ny.gov

or

518-408-1021, option 1

Monday – Friday

8:30 AM – 12:00 PM

1:00 PM – 4:00 PM

MAPP Customer Care CenterMAPP-customercarecenter@cma.comPhone: 518-649-4335

CANS-NY Trainingsupport@CANSTraining.com

Or

www.canstraining.com and click on contact us

Commerce Accounts Management Unit (CAMU)

866-529-1890

Additional Information and Support