TBI/NHTD Waiver Services and CFCO Services

Draft Crosswalk, December 17, 2015

  • Crosswalk is also available in Portable Document Format (PDF)
Waiver Service* Proposed Waiver Transition Information CFCO State Plan Amendment Information
Assistive Technology Assistive Technology Definition: Assistive technology means an item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants. Assistive technology service means a service that directly assists a participant in the selection, acquisition, or use of an assistive technology device. Assistive technology includes–
  1. the evaluation of the assistive technology needs of a participant, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the participant in the customary environment of the participant;
  2. services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
  3. training or technical assistance for the participant, or, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and
  4. training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants.
Assistive Devices (Technology) Definition: Any category of durable medical equipment, mechanical apparatus, electrical appliance, or instrument of technology used to assist and enhance an individual´s independence in performing any activity of daily living. Examples of assistive technology include, but are not limited to: motion and sound sensors, two way communication systems, automatic faucet and soap dispensers, toilet flush sensors, incontinent sensors and fall sensors.

Electronic Back–up Systems Definition: Electronic devices to secure help in an emergency for safety in the community and other reminders that will help an individual with activities such as medication management, eating or other monitoring activities.

Examples of electronic devices include PERS, medication reminders, medical monitoring devices, and alert systems for meal preparation, ADL and IADL supports that increase an individual´s independence.
  Limit to $15,000 per 12 month period. Limits
Assistive Technology costs cannot exceed $15,000 per year.
Community Integration Counseling Service Definition
CIC is an individualized service designed to assist the participant to more effectively manage the emotional difficulties associated with adjusting to and living in the community. It is a counseling service provided to a participant coping with altered abilities and skills, the need to revise long term expectations, and changed roles in relation to significant others. This service is generally provided in the provider´s office or the participant´s home. It is available to participants and anyone involved in an ongoing significant relationship with the participant when the issues to be discussed relate directly to the participant. The participant must be present at all CIC sessions.
Not a CFCO service.
Community Transitional Services (CTS) Community Transitional Services Definition
Community Transitional Services are non–recurring set–up expenses for individuals who are transitioning from an institutional to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. Allowable expenses are those necessary to enable a person to establish a basic household that do not constitute room and board and may include: (a) security deposits that are required to obtain a lease on an apartment or home; (b) essential household furnishings and moving expenses required to occupy and use a community domicile, including furniture, food preparation items, and bed/bath linens; (c) set–up fees or deposits for utility or service access; (d) services necessary for the individual´s health and safety such as pest eradication and one–time cleaning prior to occupancy; and (e) moving expenses. Community Transitional Services are furnished only to the extent that they are reasonable and necessary as determined through the plan of care development process, clearly identified in the plan and the person is unable to meet such expense or when the services cannot be obtained from other sources. Community Transitional Services do not include monthly rental or mortgage expense; food, regular utility charges; and/or household appliances or items that are intended for purely diversional/recreational purposes.
Transition Services Definition
Establishing a household in the community from an institutional setting.

Expenditures for transition costs in accordance with 441.520(b)(1) such as rent and utility deposits, first month´s rent and utilities, bedding, basic kitchen supplies, and other necessities required for an individual to make the transition from a nursing facility, institution for mental diseases, or intermediate care facility for individuals with development/intellectual disabilities, or a provider controlled residence certified by OPWDD to a community–based non–certified home setting where the individual resides. Limited to individuals transitioning from a nursing facility, IMD, or an ICF/IID to a home or community–based setting where the individual resides. Transition services will be limited to: moving and move–in costs including movers, cleaning and security deposits, payment for background/credit check (related to housing), initial deposits for apartments, heating, lighting and phone; and payment of previous utility bills that may prevent the individual from receiving utility services and basic household furnishings (i.e., bed) and other items necessary to re–establish a home. Section 441.520(b)(1) of Title 42 Federal Public Health regulations states: "Expenditures for transition costs such as rent and utility deposits, first month´s rent and utilities, bedding, basic kitchen supplies, and other necessities linked to an assessed need for an individual to transition from a nursing facility, institution for mental diseases, or intermediate care facility for Individuals with Intellectual Disabilities to a home and community–based setting where the individual resides."
Limit to $5,000 per facility discharge.
Limit to a one–time expense of $5,000.
Environmental Modifications Environmental Modification Definition
Home Modifications

Those physical adaptations to the private residence of the participant or the participant´s family, required by the participant´s service plan, that are necessary to ensure the health, welfare and safety of the participant or that enable the participant to function with greater independence in the home. Such adaptations include the installation of ramps and grab–bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the participant.

Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the participant. Adaptations that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair).

Vehicle Modifications
Adaptations or alterations to an automobile or van that is the participant´s primary means of transportation in order to accommodate the special needs of the participant. Vehicle adaptations are specified by the plan of care as necessary to enable the participant to integrate more fully into the community and to ensure the health, welfare and safety of the participant. The following are specifically excluded:
  1. Adaptations or improvements to the vehicle that are of general utility, and are not of direct medical or remedial benefit to the individual;
  2. Purchase or lease of a vehicle; and
  3. Regularly scheduled upkeep and maintenance of a vehicle except upkeep and maintenance of the modifications.
Environmental Modification Definition
Modifications are provided in accordance with 441.520(b)(2).

Section 441.520(b)(2) of Title 42 Federal Public Health regulations states: "Expenditures relating to a need identified in an individual´s person–centered service plan that increases an individual´s independence or substitutes for human assistance, to the extent that expenditures would otherwise be made for the human assistance."
Limit to $25,000 per 36 month period
Environmental modifications may not exceed $15,000 without prior approval of DOH. Vehicle modifications are limited to the primary vehicle of the recipient and may not exceed $15,000 without prior approval of DOH.
Home and Community Support Services (HCSS) HCSS Definition
Home and Community Support Services (HCSS) are only appropriate when oversight and/or supervision is necessary as a discrete service to maintain the health and welfare of a participant living in the community. HCSS may also include personal care assistance with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). HCSS is not a companion service. The service must be provided under the direction and supervision of a Registered Professional Nurse (RN) based on an assessment of the individual´s needs and supported by physicians orders.

Oversight and/or supervision is necessary to protect a cognitively impaired individual from adverse outcomes related to his/her activities (for example, wandering or leaving the stove on unattended). Oversight and/or supervision includes cueing, prompting, directing and instructing. If a participant´s need for oversight/supervision warrant HCSS during the night, the HCSS staff must remain awake throughout the duration of time assigned to the participant.
Definition of "Assistance with ADLs, IADLs and health–related tasks through hands–on assistance, supervision, and/or cueing" The State will cover personal care services and supports related to core ADLs including: assistance with bathing/personal hygiene/grooming, dressing, eating, mobility (ambulating, transferring and positioning), and toileting.

In addition, personal care services and supports will be available to core IADLS, including: managing financing; providing or assisting with transportation (in conjunction with approved service noted in service plan); shopping for food, clothes and other essentials; meal preparation; using the telephone and/or other communication devices; medication management; light housekeeping; and laundry. Health–related tasks are specific tasks related to the needs of an individual, which can be delegated or assigned by licensed health–care professionals under State law to be performed by a direct care worker. These tasks include, but are not limited to: performing simple measurements and tests; assisting with the preparation of complex modified diets; assisting with a prescribed exercise program; pouring, administering and recording the administration of medications; assisting with the use of prescribed medical equipment, supplies and devices; assisting with special skin care; assisting with a dressing change; and assisting with ostomy care.
Home Delivered/Congregate Meals Home Delivered/Congregate Meals Definition
Meals for participants who cannot prepare or obtain nutritionally adequate meals for themselves, or when the provision of such meals will decrease the need for more costly supports to provide in–home meal preparation.
Congregate and/or Home Delivered Meal Services
Up to two meals per day for individuals who cannot prepare or access nutritionally adequate meals for themselves, and the cost of this service is less than it would be to have someone provide in–home meal preparation.
Independent Living Skills Training (ILST) ILST Definition
Training to improve or maintain the participant´s ability to live as independently as possible by focusing on essential community living skills such as task completion, money management, interpersonal skills, sensory/motor skills, problem solving skills and the ability to maintain a household.
Could be a CFCO service.

Definition of "Acquisition, maintenance, and enhancement of skills necessary for the individual to accomplish ADLs, IADLs, and health–related tasks"

The State will cover services and supports related to assistance with functional skills training through hands–on assistance, supervision, and/or cueing to accomplish the ADL, IADLs, and health–related tasks. Services will be specifically tied to the functional needs assessment and person–centered service plan and are a means to maximize independence and integration in the community, preserve functioning and defer or eliminate the likelihood of future institutional placement. These services include: assessment, training, and supervision of, or assistance to, an individual with issues related to self–care, life safety, medication management, communication skills, mobility, community transportation skills, community integration, reduction/elimination of maladaptive behaviors including inappropriate social behaviors, problem solving skills, money management, and skills to maintain a household, as it relates to the provision of ADLs, IADLs, and health–related tasks.
Moving Assistance Moving Assistance Definition
Transport of the participant´s possessions and furnishings when moving from an inadequate or unsafe housing situation or to a location where more informal supports will be available within the State of New York.
Moving Assistance
Transport of personal belongings.
Positive Behavioral Interventions & Supports PBIS Definition
Services are provided to participants who have significant behavioral difficulties that jeopardize their ability to remain in the community of choice. The primary goal of PBIS services is to decrease the intensity or frequency of targeted behaviors and to teach more socially appropriate behaviors.
Not a CFCO service.
Service Coordination CMS Core Service Definition of Case Management
Services that assist participants in gaining access to needed waiver and other State plan services, as well as medical, social, educational and other services, regardless of the funding source for the services to which access is gained. Case managers are responsible for the ongoing monitoring of the provision of services included in the participant´s service plan and/or participant health and welfare.
Not a CFCO service.
Structured Day Programs Structured Day Program Definition
Provision of regularly scheduled activities in a non–residential setting, separate from the participant´s private residence or other residential living arrangement, such as assistance with acquisition, retention, or improvement in self–help, socialization and adaptive skills that enhance social development and develop skills in performing activities of daily living and community living.
Community Habilitation – Definition as presented in the OPWDD Comprehensive Waiver
Community Habilitation will offer skill training and supports as follows: adaptive skill development, assistance with activities of daily living, travel, health, adult educational supports, communication, social skills, leisure skills, money management, socially appropriate behaviors, life safety, hands–on–assistance provided by staff as necessary, professional oversight services as necessary (for example QIDP oversight), self–advocacy, informed choice, community inclusion, and relationship building. Community Habilitation may also include personal care, health care, protective oversight and supervision, and program–related transportation but these components do not constitute the entirety of the service.

Community Habilitation services are generally not vocational in nature. However, Community Habilitation services do support individuals in their attainment of life goals, including career goals. Therefore, Community Habilitation may include habilitation activities such as volunteering, learning about different types of jobs, visiting job sites and other experiences that are not long–term vocational commitments; yet the person is exposed to the world of work and the experience broadens his or her understanding of the types of employment they may wish to actively pursue in the future.

Once an individual is employed, community habilitation services may be used in a work setting to facilitate and promote independence, community inclusion, relationship building and socially appropriate behaviors. Community habilitation services cannot be used for job coaching related activities and cannot be provided at the same time as supported employment services.

Could be a CFCO service.
Social Transportation Non–Medical Transportation
Core Service Definition

Service offered in order to enable waiver participants to gain access to waiver and other community services, activities and resources, as specified by the service plan. This service is offered in addition to medical transportation required under 42 CFR §431.53 and transportation services under the State plan, defined at 42 CFR §440.170(a) (if applicable), and does not replace them. Transportation services under the waiver are offered in accordance with the participant´s service plan. Whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge are utilized.
Transportation services will only be available to a location that is identified in the person–centered service plan pursuant to a functional need identified in the person´s assessment.
Specifically, NY makes the following assurances:
  • The functional needs assessment and the person–centered plan indicate the need for a medical escort, the need for transportation to medical appointments and traveling around and participating in the community;
  • There is a checks and balances system in place to monitor services to ensure that duplicate billing doesn´t take place; and
  • CFCO SPAs that allow personal care attendants to provide transportation to medical appointments should follow the guidelines that Non–Emergency Medical Transportation uses to ensure the integrity of the transportation services.

* Waiver services that the Services & Workforce Subcommittee agreed would not be added to the managed care benefit package are not included in this chart (Peer Mentoring and Home Visits by Medical Personnel).

Comparable services that are already included in the managed care benefit package, are not CFCO services, and this Subcommittee agreed that no action was needed for the purposes of the transition are not included in this chart (Nutrition/Nutritional Counseling, Respiratory Behavior Therapy, Respite Care, Substance Abuse Counseling, and Wellness Counseling).