1915(c) Children’s Waiver and 1115 Waiver Amendments
The State has been working with CMS to implement the Children’s Medicaid System Transformation. On May 9, 2017, the State submitted to CMS a proposed 1115 Waiver Amendment and on November 14, 2017, the State submitted to CMS a Draft Transition Plan (which included comments from stakeholders) to implement the proposed 1115 Waiver Amendment. In April 2018, the State submitted to CMS a revised 1115 Waiver Amendment (April 24, 2018) and a revised Draft Transition Plan (April 30, 2018) to reflect changes to the timeline for implementing the Children’s Medicaid System Transformation. On June 21, 2018, CMS advised the State that 1915 waiver vehicles, rather than the sole use of the 1115 Waiver Amendment, must be used to implement the Children’s Medicaid System Transformation. As a result, the State is now proposing the Children’s Medicaid System Transformation be implemented under 1915(c) waiver and 1115 waiver amendments.
The proposed 1915(c) and 1115 waiver amendments, and timelines for implementation, are subject to CMS approvals and thus may be subject to further modification. The Children’s 1915(c) HCBS waiver as now been approved with an effective date of April 1, 2019.
CANS-NY Information and Resources can be found on the Health Home Serving Children page
Overview of 1915(c) Children’s Waiver and 1115 Waiver
Effective no earlier than April 1, 2019, the following six 1915(c) Home and Community Based Services (HCBS) waivers will be consolidated into a single, 1915(c) Children’s Waiver:
- Office of Mental Health (OMH) Serious Emotional Disturbance (SED) waiver #NY.0296;
- Department of Health (DOH) Care at Home (CAH) I/II waiver #NY.4125;
- Office for People with Developmental Disabilities (OPWDD) Care at Home waiver #40176; and
- Office of Children and Families (OCFS) Bridges to Health (B2H) SED waiver #NY.0469, B2H Developmental Disability (DD) waiver #NY.0470, and B2H Medically Fragile waiver #NY.0471.
The 1915(c) Children’s Waiver will:
- Streamline the children’s HCBS administration to have more consistent eligibility processes and benefits across all populations.
- Provide a single HCBS benefit package to children meeting institutional level of care (LOC) functional criteria. Over a three-year period, eliminate the use of waiting lists related to HCBS capacity under the waiver. All of the HCBS services authorized under the six current 1915(c) children’s waivers will continue to be authorized as either an HCBS authorized under the 1915(c) Children’s Waiver or a new State Plan service.
- Provide Health Home care management to children eligible for HCBS and an administrative alternative for children that may opt of Health Home. Children currently enrolled in one of the six 1915(c) waivers will begin to transition to Health Home no earlier than January 1, 2019.
- Authorize Family Peer, Youth Peer, and Crisis Intervention to HCBS eligible children between April 1, 2019 and the dates those services become State Plan services (July 1, 2019 for peer and January 1, 2020 for Youth and Crisis).
The 1115 waiver, which will be implemented concurrently with the 1915(c) Children’s Waiver will:
- Incorporate certain Medicaid State Plan behavioral health services into the MMMC and HIV SNP contracts for enrolled children.
- Include newly aligned HCBS authorized under the concurrent 1915(c) Children’s Waiver in the managed care benefit package.
- Remove the exemption from mandatory enrollment into MMMC and HIV SNPS for children in the 1915(c) Children’s Waiver, unless the child is otherwise exempt or excluded from enrollment (i.e., available comprehensive Third Party Health Insurance and/or Medicare, or Medically Needy child who is provisionally eligible). Children who are otherwise exempt or excluded from enrollment into MMMC and enrolled in 1915(c) Children’s waiver will remain in, or receive FFS Medicaid, including HCBS, until those exemptions or exclusions from MMMC and HIV SNP enrollment are removed.
- Offer State Plan CFCO services to LOC children eligible for Medicaid solely because of receipt of HCBS services (i.e., Family-of-One children not eligible under the State Plan but who meet institutional admission criteria and receive HCBS services).
- No earlier than July 2019, remove the exclusion from MMMC enrollment for children in the care of a voluntary foster care agency, and include Residential Supports and Services (to be authorized under a separate State Plan Amendment) in MMC benefit package.
- Authorize transitional rates for waiver providers under six children’s 1915(c) waivers that will transition from waiver care management rates to Health Home rates. Provide conflict free case management for children receiving HCBS and Health Home care management.
- No earlier than 2022, expand Medicaid services to offer an HCBS benefit package identical to the 1115 HCBS package (but not including State Plan CFCO services) to children that meet targeting criteria and having functional needs at-risk of institutional care under the Demonstration, i.e., at-risk HCBS Level of Need (LON) services.
1915c Children’s Waiver Amendment
The State has been working with CMS to implement the Children’s Medicaid System Transformation. With stakeholder feedback and Interagency collaboration the State has submitted amendment changes to the approved HCBS Waiver Application NY 4125 R05.02. Those changes are outlined in track changes in the document below titled: Proposed Amendment Changes to HCBS Waiver Application NY 4125 R05.02-July 2019. The proposed effective date for these changes is August 1, 2019. If you have questions on the changes please submit questions to BH.Transition@health.ny.gov
- APPROVED Effective October 1, 2019 HCBS Waiver Application NY 4125 R05.06 (PDF) – October 2019
- APPROVED Effective August 1, 2019 HCBS Waiver Application NY 4125 R05.02 (PDF) – August 2019
- Proposed Amendment Changes to HCBS Waiver Application NY 4125 R05.02 for October 2019 (PDF) – August 2019
- Proposed Amendment Changes to HCBS Waiver Application NY 4125 R05.02 for August 2019 (PDF) – July 2019
- APPROVED Effective April 1, 2019 HCBS Waiver Application NY 4125 R05.02 (PDF) – April 1, 2019
- 1915c Children’s Waiver Stakeholder feedback (PDF) – October 18, 2018
Archive
Children's 1115 Waiver Amendment
- Approved 1115 Demonstration Project Number 11-W-001142/2 Effective August 2, 2019
- Children’s 1115 Waiver Amendment (PDF) – April 2018
- Children’s 1115 Waiver Amendment (PDF) – May 2017
Children’s HCBS Waiver Provider Information/Guidance
- Understanding Care Management Requirements and Medicaid Status Impact Regarding HCBS Eligible Children/Youth Webinar (External Link) – October 31, 2019
- Care Management Requirements for HCBS Eligible Children (PDF)
- Medicaid Status Impact on HCBS Eligible Children (PDF)
- Annual HCBS LOC Requirement and Reconcile Process (PDF) – September 30, 2019
- Informational Update on the October 1, 2019 carve in of Children’s Waiver HCBS in Medicaid Managed Care Plans (MMCP) (PDF)
- HCBS Providers to Establish Contact and Relationships with the Medicaid Managed Care Plans (PDF)
- Children's Waiver and Nursing Services Guidance (PDF) – July 2019
- Guidance for Providers Regarding Student Interns and Limited Permits for CFTSS and HCBS Required to be Provided by a Licensed Practitioner (PDF) – June 2019
- HCBS Quick Reference Guide (PDF) – May 17, 2019
- HCBS Service Plan under the 1915c Children’s Waiver (PDF) – May 15, 2019
- Children's HCBS Provider Training Requirements Memo (PDF) – May 15, 2019
- Consolidated Children’s Waiver and Mediciad Case Processing Requirements 19 OHIP/ADM-02 (PDF) – May 10, 2019
- Children’s Home and Community Based Services Brochure (PDF) – April 17, 2019
Environmental Modifications (EMOD), Vehicle Modifications (VMOD), Adaptive and Assistive Technology (AT) and Non-medical transportation (NMT)
- Children’s Waiver EMOD, VMOD, AT and LDSS Contact List – October 18, 2019 (PDF)
- Children’s Waiver Environmental Modification, Vehicle Modification, and Assistive Technology for Transition to Medicaid Managed Care – October 1, 2019 (PDF)
- AT Service Authorization Guidelines – HTML – PDF
- EMOD Service Authorization Guidelines – HTML – PDF
- VMOD Service Authorization Guidelines – HTML – PDF
- Description and Cost Projection Form – HTML – PDF
- Final Cost Form – HTML – PDF
- Authorization & Payment; Adaptive and Assistive Equipment, Vehicle Modifications, Environmental Modifications, & Non–Medical Transportation – June 6, 2019 (PDF)
Environmental, Vehicle Modification and Adaptive and Assistive Technology Forms for LDSS
- NMT materials are available on the eMedNY site under the Transportation Manual on the Transportation page found HERE (External Link)
- Non-Medical Transportation (NMT) Authorization Process for Child/Youth in FFS (External Link)
- NYS DOH Plan of Care Grid for Non-Medical Transportation for Children's Home and Community Based Services (HCBS) (External Link)
- NMT Service Description (External Link)
Non-Medical Transportation (NMT)
HCBS Provider Manual and Rates
- Guide to Children’s Home and Community Based Services Provider Manual Updates (PDF) – July 3, 2019
- Children’s Home and Community Based Services Provider Manual (PDF) – July 3, 2019
- Health Home Monitoring: Reportable Incidents Policies and Procedures #HH0005 (PDF) – Revised October 7, 2019
- Health Home Incident Reporting Form (PDF) – Updated September 2019
- Health Home Reportable Incidents Quarterly Report (XLSX)
- Children’s Health Home Transition Rates – Effective January 1, 2019 (PDF)
- FINAL HCBS Rate Summary – May 31, 2019 (PDF)
- FINAL HCBS Rate Summary YPST, CI – October 22, 2019 (PDF)
- Children’s Medicaid System Transformation: HCBS Rates & SPA Rate Code Review – December 21, 2017 (PDF)
HCBS Provider Manual
Rates
Eligibility Forms
For all documents pertaining to the CANS-NY, please visit the Health Homes Serving Children webpage under the "Child Adolescent Needs and Strengths – NY (CANS–NY)" section
- Freedom of Choice – DOH-5276 (PDF)
- Licensed Practitioner of the Healing Arts (LPHA) Attestation – DOH-5275 (PDF)
Forms and Documents for Medically Fragile Target Population
Plan of Care
- Children’s HCBS POC Workflow & MMCP Service Authorization for HCBS Providers (PDF) – October 18, 2019
- Children’s Home and Community Based Services (HCBS) Plan of Care (POC) Workflow Policy (PDF)
- Children’s HCBS POC Workflow FAQ (PDF)
- Children's HCBS Referral Form to HCBS Provider- Fillable (PDF)
- Children's HCBS Authorization and Care Manager Notification Form- Fillable (PDF)
- Children’s HCBS POC Workflow Webinar (PDF) – August 28, 2019
- Medicaid Managed Care Plans’ Contact Information (PDF)
- Lead Health Home Serving Children’s Contact Information for MMCP (XLSX)
- Health Home Plan of Care Policy #HH0008 (PDF) – July 30, 2019
- Person Centered Service Planning Guidelines (PDF) – December 19, 2018
- Services Access Documentation (PDF) – March 2019
- Remedial Process to Sharing the Plan of Care’s Information with Medicaid Managed Care Plans in Preparation of October 1, 2019 (PDF)
Notice of Determination
Children and Youth Evaluation Services (C-YES)
- C-YES Steps to apply for Home and Community Based Services (HCBS) – November 2019 (PDF)
- C-YES Referral Form Instructions – April 18, 2019 (PDF)
The Children and Youth Evaluation Service (C-YES) is a statewide program that determines whether a child/youth (under age 21) is eligible for Home and Community Based Services (HCBS) for children who do not currently have Medicaid or for children who opt-out of the Health Home Serving Children’s program. To make a referral or learn more information – C-YES
Capacity Management
OPWDD Resources
- Overview of Services Available to Health Home Serving Children and Care Coordination Organization/Health Home Enrollees – September 2019 (PDF)
- OPWDD Children’s Liaison and HCS Secure File Transfer Resource (PDF)
- Transfer Process between Children’s and OPWDD Comprehensive Waiver for Care Management and Waiver Services (PDF)
- DDRO Manual for Children's Waiver – August, 2019 (PDF)
- Home and Community Based Services (HCBS) Level of Care (LOC) Eligibility Determination- For DDROs and Care Managers/C-YES – June 14, 2019 (PDF)
Archive
- Draft Final Transition Plan for the Children’s Medicaid Health and Behavioral Health System Transformation – August 7, 2018 (PDF)
- Required Steps to be Completed for the Transition of 1915(c) Waiver Care (PDF)
- 1915c Transitioning Providers and Lead Health Homes: Enrollment and Billing During the Transition UPDATE – February 25, 2019 (PDF)
- CLARIFICATION for Transitioning 1915c DOH/OPWDD Care at Home Waiver Providers – January 25, 2019 (PDF)
- Transition to Health Home Care Management Guidance for Providers – January 11, 2019 (PDF)
- Talking Points for transitioning 1915(c) Home and Community Based Services (HCBS) Waiver Providers to families (PDF)
- Children’s Medicaid Transformation Update Webinar – February 13, 2019 (PDF)
- Children and Youth Evaluation Service (C-YES): the State-designated Independent Entity (IE) for Children’s HCBS Part I: An overview of the role of C-YES during the February 1, 2019 – March 31, 2019 transition period – January 31, 2019 (PDF)
- 1915(c) Transition to Health Homes In-Person PPT Training (PDF)
- Direct Noticing Draft Schedule – updated January 2019 (PDF)
- FAQ for Care Managers Regarding Transition and Services (PDF)
- Child Transitioned from a 1915c Waiver Quick Reference Guide (PDF)
- Processing a CANS-NY Assessment Tips and Quick Reference Guide (PDF)
- Children’s Health Home Transitional Billing Process – January 16, 2019 (PDF)
- Letter to Medicaid Families Jan 1 2019 CFTSS (PDF)
- Member Handbook Insert-New CFTSS (PDF)
- Letters and Member Handbook announcement (PDF)
- Accessing Health Home Systems for 1915c Waiver Providers (PDF)
- Additional guidance documents regarding HCS user account creation and other system readiness can be found on our Lead Health Home Resource Center within the Administrative Requirements for Health Homes" expandable section.
- Required Training for 1915c Agencies Transitioning to Health Home Care Management (PDF)