Children’s Health and Behavioral Health Medicaid System Transformation Children’s Home and Community Based Services Manual September 2020 Send questions to [email protected] Children’s Home and Community Based Services (HCBS) Manual CONTENTS INTRODUCTION ........................................................................................................................................... 4 Vision and Goals ........................................................................................................................................... 5 Provider Requirements ................................................................................................................................. 5 Designation ............................................................................................................................................... 5 Medicaid Enrollment .................................................................................................................................. 6 Criminal History and Background Checks ................................................................................................ 6 HCBS Eligibility and Enrollment .................................................................................................................... 7 HCBS Eligibility Reauthorization ............................................................................................................. 11 Participant Placed in an HCBS Restricted Setting .................................................................................. 12 Capacity Management ............................................................................................................................ 12 Care Management and Monitoring Access to Care for HCBS .................................................................... 13 Person-Centered Plan of Care .................................................................................................................... 15 HCBS Plan of Care Workflow ..................................................................................................................... 18 Participants Rights and Protections ............................................................................................................ 19 Freedom of Choice .................................................................................................................................. 20 Fair Hearing ............................................................................................................................................ 20 Incident Reporting ................................................................................................................................... 20 Grievances and Complaints .................................................................................................................... 21 Conflict Free Case Management ............................................................................................................ 21 Service Definitions ...................................................................................................................................... 22 Community Habilitation ........................................................................................................................... 22 Day Habilitation ....................................................................................................................................... 27 Caregiver/Family Supports and Services ................................................................................................ 31 Respite .................................................................................................................................................... 34 Prevocational Services ............................................................................................................................ 38 Supported Employment ........................................................................................................................... 42 Community Self-Advocacy Training and Supports ................................................................................. 45 Palliative Care – Expressive Therapy ..................................................................................................... 48 Palliative Care – Massage Therapy ........................................................................................................ 51 Palliative Care – Bereavement Service .................................................................................................. 54 Palliative Care – Pain and Symptom Management ................................................................................ 57 Adaptive and Assistive Equipment .......................................................................................................... 59 Vehicle Modifications .............................................................................................................................. 62 Environmental Modifications ................................................................................................................... 65 VERSION 2020-2 SEPTEMBER 2020 PAGE | 2 Children’s Home and Community Based Services (HCBS) Manual Non-Medical Transportation .................................................................................................................... 68 Appendices ................................................................................................................................................. 72 Appendix A: Glossary of Key Terms ....................................................................................................... 72 Appendix B: HCBS Settings Overview .................................................................................................... 78 Appendix C: Person-Centered Planning Guidance ................................................................................ 81 Appendix D: Utilization Management/Medical Necessity Guidelines for Children’s Aligned Home and Community Based Services .................................................................................................................... 82 Appendix E: Prior/Concurrent Authorization Grid ................................................................................... 83 Appendix F: Table of Responsibilities for HCBS Workflow ..................................................................... 85 Appendix G: HCBS Plan of Care Workflow ............................................................................................ 86 Appendix H: Community Habilitation Guidelines .................................................................................... 97 Appendix I: Training Grid ........................................................................................................................ 99 Appendix J: Medicaid Eligibility Guidance ............................................................................................ 101 Appendix K: HCBS LOC Eligibility Guidance ........................................................................................ 111 Appendix L: Health Home Serving Children Policy Information ............................................................ 121 Appendix M: Billing and Claiming Resources ....................................................................................... 123 Appendix N: Service Animal Guidance ................................................................................................. 124 VERSION 2020-2 SEPTEMBER 2020 PAGE | 3 Children’s Home and Community Based Services (HCBS) Manual INTRODUCTION Home and Community Based Services (HCBS) are designed to allow children and youth to participate in developmentally and culturally appropriate services through Medicaid. New York State (NYS) is committed to serving individuals in the least restrictive environment possible by providing services and supports to children/youth and their families at home and in the community. HCBS are designed for people who, if not receiving these services, would require the level of care provided in a more restrictive environment such as a long-term care facility or psychiatric inpatient care and for those at risk of elevating to that level of care. The Children’s Medicaid System Transformation for individuals under the age of 21 includes the alignment of the following NYS children’s waivers previously accessible under the authority of the 1915(c) amendment of the Federal Social Security Act: Office of Children and Family Services (OCFS) Bridges to Health (B2H) Serious Emotional Disturbance (SED), B2H Developmental Disabilities (DD), B2H Medically Fragile (MedF), the Office of Mental Health (OMH) SED Waiver, Office for People With Developmental Disabilities (OPWDD) Care at Home (CAH) IV Waiver, and the Department of Health (DOH) operated Care at Home (CAH) I/II Waiver. The Office of Addiction Services and Supports (OASAS), OCFS, OMH, OPWDD, and DOH have collaborated to create a newly aligned service array of HCBS benefits for children meeting specific diagnostic and functional criteria. The new 1915(c) Children’s Waiver and 1115 Medicaid Redesign Team (MRT) Waiver, with approval from the Centers for Medicare and Medicaid Services (CMS), provides NYS the authority for these HCBS benefits. The waiver includes person-centered planning requirements (see Appendix C) and specifies transitional coverage requirements