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
• 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: [email protected]. 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: [email protected] contact the Health Home Program at the Department of Health at 518.473.5569
• Specific Questions/Comments regarding Transition services [email protected]
• 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
or
518-408-1021, option 1
Monday – Friday
8:30 AM – 12:00 PM
1:00 PM – 4:00 PM
MAPP Customer Care [email protected]: 518-649-4335
CANS-NY [email protected]
Or
www.canstraining.com and click on contact us
Commerce Accounts Management Unit (CAMU)
866-529-1890
Additional Information and Support