DRAFT
Attachment 9
Managed Care Service Provider Qualifications
CIC, ILST, PBIS, SC, SDP
- Attachment is also available in Portable Document Format (PDF, 135KB)
| Service | Provider Qualifications |
|---|---|
| Community Integration Counseling (CIC) | Provider Qualifications: CIC may be provided by any not-for-profit or for profit health and human services agency or independent provider. Not-for-profit health and human services agencies must have a Certificate of Incorporation filed with the NYS Department of State pursuant to Section 402 of the NYS Not-for-Profit Corporation Law for the purposes of providing health and/or human services related activities. For profit health and human services agencies must have a Certificate of Incorporation pursuant to Section 402 of the NYS Business Corporation Law; Certificate of Incorporation pursuant to Section 1503 of the NYS Business Corporation Law; Articles of Organization pursuant to Section 203 of the NYS Limited Liability Company Law; Articles of Organization pursuant to Section 1203 of the NYS Limited Liability Law; Certificate of Limited Partnership pursuant to Section 121-201 of the NYS Revised Limited Partnership Act; or Certificate of Registration pursuant to Section 121-1500(a) of the NYS Partnership Act, for the purpose of providing health and/or human services related activities. The employer is responsible for verifying that the individual(s) providing CIC maintain the needed license, registration or certification and must verify the license, registration or certification upon hire and annually thereafter. All degrees must be from an accredited college or university, as accepted by the New York State Education Department (NYSED). The following staff may provide CIC without supervision, and are qualified to supervise those who require it:
Supervisors are responsible for providing ongoing supervision and training to staff. Any existing provider of CIC enrolled as a provider at the time of transition is approved to provide the same specific service during the 2 year continuity of care transition period. Managed care organizations are required to contract with these existing providers if the existing provider serves 5 or more waiver participants at the time of transition. The grandfathering of existing providers sunsets after the two year continuity of care transition period or if the staff person terminates employment with the current employer within the 2 year transition period. Independent Providers: Individuals meeting the educational requirements and the 2 year work experience requirements described above may be employed as an independent provider and provide this service. |
| Independent Living Skills Training (ILST) | Provider Qualifications: ILST may be provided by any not-for-profit or for profit health and human services agency or independent provider. Not-for-profit health and human services agencies must have a Certificate of Incorporation filed with the NYS Department of State pursuant to Section 402 of the NYS Not-for-Profit Corporation Law for the purposes of providing health and/or human services related activities. For profit health and human services agencies must have a Certificate of Incorporation pursuant to Section 402 of the NYS Business Corporation Law; Certificate of Incorporation pursuant to Section 1503 of the NYS Business Corporation Law; Articles of Organization pursuant to Section 203 of the NYS Limited Liability Company Law; Articles of Organization pursuant to Section 1203 of the NYS Limited Liability Law; Certificate of Limited Partnership pursuant to Section 121-201 of the NYS Revised Limited Partnership Act; or Certificate of Registration pursuant to Section 121-1500(a) of the NYS Partnership Act, for the purpose of providing health and/or human services related activities. The employer is responsible for verifying that the individual(s) providing ILST maintain the needed license, registration or certification and must verify the license, registration or certification upon hire and annually thereafter. All degrees must be from an accredited college or university, as accepted by the New York State Education Department (NYSED). The following staff may provide ILST without supervision, and are qualified to supervise those who require it:
Any existing provider of ILST enrolled as a provider at the time of transition is approved to provide the same specific service during the 2 year continuity of care transition period. Managed care organizations are required to contract with these existing providers if the existing provider serves 5 or more waiver participants at the time of transition. The grandfathering of existing providers sunsets after the two year continuity of care transition period or if the staff person terminates employment with the current employer within the 2 year transition period. Independent Providers: Individuals who meet the educational requirements of a supervisor and have 3 years of experience providing functional based assessments and ILST to seniors and/or individuals with physical and/or cognitive disabilities may provide ILST services as an independent provider. |
| Positive Behavioral | Provider Qualifications: PBIS services may be provided by any not-for-profit or for profit health and human services agency or independent provider. |
| Interventions & Supports (PBIS) | Not-for-profit health and human services agencies must have a Certificate of Incorporation filed with the NYS Department of State pursuant to Section 402 of the NYS Not-for-Profit Corporation Law for the purposes of providing health and/or human services related activities. For profit health and human services agencies must have a Certificate of Incorporation pursuant to Section 402 of the NYS Business Corporation Law; Certificate of Incorporation pursuant to Section 1503 of the NYS Business Corporation Law; Articles of Organization pursuant to Section 203 of the NYS Limited Liability Company Law; Articles of Organization pursuant to Section 1203 of the NYS Limited Liability Law; Certificate of Limited Partnership pursuant to Section 121-201 of the NYS Revised Limited Partnership Act; or Certificate of Registration pursuant to Section 121-1500(a) of the NYS Partnership Act, for the purpose of providing health and/or human services related activities. The employer is responsible for verifying that the individual(s) providing PBIS maintain the needed license, registration or certification and must verify the license, registration or certification upon hire and annually thereafter. All degrees must be from an accredited college or university, as accepted by the New York State Education Department (NYSED). The two key positions in PBIS service are the Program Director and the Behavioral Specialist. Each PBIS provider must employ a Program Director. The Program Director is responsible for assessing the member and developing the PBIS plan for each member. The Program Director may perform the function of a Behavioral Specialist or supervise the Behavioral Specialist. The Behavioral Specialist may be responsible for the development and/or implementation of the Detailed Plan under the direction of the Program Director. If a provider has more than one individual who meets the qualifications for Program Director, each of these qualified individuals can develop PBIS plans. The Program Director must be a:
The Behavioral Specialist is responsible for implementation of the Detailed Plan under the direction of the Program Director. The Behavioral Specialist must have at least 1 year of experience working with individuals and/or seniors with disabilities or behavioral difficulties and be a:
Any existing provider of PBIS enrolled as a provider at the time of transition is approved to provide the same specific service during the 2 year continuity of care transition period. Managed care organizations are required to contract with these existing providers if the existing provider serves 5 or more waiver participants at the time of transition. The grandfathering of existing providers sunsets after the two year continuity of care transition period or if the staff person terminates employment with the current employer within the 2 year transition period. Independent Providers: Individuals must meet the qualifications of Program Director of the PBIS Program described above in order to be an independent provider of PBIS services. |
| Service Coordination (SC) | Provider Qualifications: SC may be provided by any not-for-profit or for profit health and human services agency. Not-for-profit health and human services agencies must have a Certificate of Incorporation filed with the NYS Department of State pursuant to Section 402 of the NYS Not-for-Profit Corporation Law for the purposes of providing health and/or human services related activities. For profit health and human services agencies must have a Certificate of Incorporation pursuant to Section 402 of the NYS Business Corporation Law; Certificate of Incorporation pursuant to Section 1503 of the NYS Business Corporation Law; Articles of Organization pursuant to Section 203 of the NYS Limited Liability Company Law; Articles of Organization pursuant to Section 1203 of the NYS Limited Liability Law; Certificate of Limited Partnership pursuant to Section 121-201 of the NYS Revised Limited Partnership Act; or Certificate of Registration pursuant to Section 121-1500(a) of the NYS Partnership Act, for the purpose of providing health and/or human services related activities. The employer is responsible for verifying that the individual(s) providing SC maintain the needed license, registration or certification and must verify the license, registration or certification upon hire and annually thereafter. All degrees must be from an accredited college or university, as accepted by the New York State Education Department (NYSED). The following staff may provide SC without supervision, and are qualified to supervise those who require it:
The following staff may provide SC without supervision, but cannot supervise those who require it:
Any existing provider of SC enrolled as a provider at the time of transition is approved to provide the same specific service during the 2 year continuity of care transition period. Managed care organizations are required to contract with these existing providers if the existing provider serves 5 or more waiver participants at the time of transition. The grandfathering of existing providers sunsets after the two year continuity of care transition period or if the staff person terminates employment with the current employer within the 2 year transition period. Independent Providers: Individuals who meet the educational requirements of a supervisor and have 3 years of experience providing Service Coordination involving multiple community resources to individuals with physical and/or cognitive disabilities may provide SC services as an independent provider. Individuals who have successfully served as a RRDS for 1 year may provide SC services as an independent provider. |
| Structured Day Program (SDP) | Provider Qualifications: SDPs may be provided by any not-for-profit or for profit health and human services agency. Not-for-profit health and human services agencies must have a Certificate of Incorporation filed with the NYS Department of State pursuant to Section 402 of the NYS Not-for-Profit Corporation Law for the purposes of providing health and/or human services related activities. For profit health and human services agencies must have a Certificate of Incorporation pursuant to Section 402 of the NYS Business Corporation Law; Certificate of Incorporation pursuant to Section 1503 of the NYS Business Corporation Law; Articles of Organization pursuant to Section 203 of the NYS Limited Liability Company Law; Articles of Organization pursuant to Section 1203 of the NYS Limited Liability Law; Certificate of Limited Partnership pursuant to Section 121-201 of the NYS Revised Limited Partnership Act; or Certificate of Registration pursuant to Section 121-1500(a) of the NYS Partnership Act, for the purpose of providing health and/or human services related activities. The employer is responsible for verifying that the individual(s) providing SDP maintain the needed license, registration or certification and must verify the license, registration or certification upon hire and annually thereafter. All degrees must be from an accredited college or university, as accepted by the New York State Education Department (NYSED). Individuals who meet one of the following qualifying educational requirements and has, at a minimum, 1 year of experience providing functional based assessments, PBIS or SDP to individuals with disabilities and/or seniors, may be a SDP Director:
The SDP must be available to provide hands-on assistance to members, and therefore, must have at least 1 employee with previous training as a PCA or CNA available to members at all times. In addition to a required Program Director and staff with PCA/CNA training, a SDP may employ additional program staff. Program staff must be at least 18 years old; be able to follow written and verbal instructions; and have the ability and skills necessary to meet the member´s needs in a SDP. Any existing provider of SDP enrolled as a provider at the time of transition is approved to provide the same specific service during the 2 year continuity of care transition period. Managed care organizations are required to contract with these existing providers if the existing provider serves 5 or more waiver participants at the time of transition. The grandfathering of existing providers sunsets after the 2 year continuity of care transition period or if the staff person terminates employment with the current employer within the two year transition period. |
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