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Children’s Health and BehavioralHealth Medicaid SystemTransformationChildren’s Home and CommunityBased Services ManualMay 2022Send questions toBH.Transition@health.ny.gov

Children’s Home and Community Based Services (HCBS) ManualTABLE OF CONTENTSIntroduction. 8Vision and Goals . 9Provider Requirements . 10Designated HCBS Provider Attestation . 10Designation . 10Medicaid Enrollment . 12Outsourced Administrative Functions . 12Re-Designation . 14De-Designation . 14Electronic Visit Verification (EVV) . 15CMS Final Rule on HCBS Settings . 16Consolidated Fiscal Report . 18Criminal History and Background Checks and Training Requirements . 18HCBS Eligibility and Enrollment . 20Notice of Decision (NOD) .23HCBS Eligibility Reauthorization . 25Participant Placed in an HCBS Restricted Setting . 26Capacity Management . 27HCBS Disenrollment . 28Disenrollment Process . 29Disharge from HCBS Process. 29Care Management and Monitoring Access to Care for HCBS. 30Care Management .30Monitoring Access to Care .30Person-Centered Plan of Care . 32Plan of Care (POC) Development .32HCBS Service Plan .33HCBS POC Workflow . 36Participants Rights and Protections . 38Freedom of Choice . 38Fair Hearing . 39Incident Reporting . 39Grievances and Complaints . 41Conflict Free Case Management . 41VERSION 2022-1MAY 2022PAGE 2

Children’s Home and Community Based Services (HCBS) ManualService Definitions . 42Community Habilitation . 42Definition .42Service Components .43Provider and Condition Requirements.43Modality .44Setting .45Limitations/Exclusions .45Certification/Provider Qualifications.46Training Requirements .47Day Habilitation . 47Definition .47Service Components .47Modality .48Setting .48Limitations/Exclusions .48Certification/Provider Qualifications.49Training Requirements .51Caregiver/Family Supports and Services . 51Definition .51Service Components .52Modality .53Setting .53Limitations/Exclusions .53Certification/Provider Qualifications.54Training Requirements .55Community Self-Advocacy Training and Supports . 55Definition .55Service Components .56Modality .57Setting .57Limitations/Exclusions .57VERSION 2022-1MAY 2022PAGE 3

Children’s Home and Community Based Services (HCBS) ManualCertification/Provider Qualifications.58Training Requirements .59Respite . 59Definition .59Service Components .59Modality .60Setting .61Limitations/Exclusions .61Certification/Provider Qualifications.62Training Requirements .64Prevocational Services . 64Definition .64Service Components .64Modality .65Setting .65Limitations/Exclusions .66Certification/Provider Qualifications.66Training Requirements .67Supported Employment. 67Definition .67Service Components .68Modality .68Setting .69Limitations/Exclusions .69Certification/Provider Qualifications.70Training Requirements .71Palliative Care – Expressive Therapy . 71Definition .71Modality .72Setting .72Limitations/Exclusions .72Certification/Provider Qualifications.72VERSION 2022-1MAY 2022PAGE 4

Children’s Home and Community Based Services (HCBS) ManualTraining Requirements .74Palliative Care – Massage Therapy . 74Definition .74Service Components .75Modality .75Setting .75Limitations/Exclusions .75Certification/Provider Qualifications.75Training Requirements .76Palliative Care – Bereavement Service . 77Definition .77Modality .78Setting .78Limitations/Exclusions .78Certification/Provider Qualifications.78Training Requirements .80Palliative Care – Pain and Symptom Management . 80Definition .80Service Components .81Modality .81Setting .81Limitations/Exclusions .81Certification/Provider Qualifications.81Training Requirements .82Adaptive and Assistive Technology . 83Definition .83Service Components .83Limitations/Exclusions .84Certification/ Provider Qualifications.85Vehicle Modifications . 86Definition .86Service Components .86VERSION 2022-1MAY 2022PAGE 5

Children’s Home and Community Based Services (HCBS) ManualLimitations/Exclusions .87Certification/Provider Qualifications.88Environmental Modifications . 89Definition .89Service Components .89Limitations/Exclusions .90Certification/Provider Qualifications.91Non-Medical Transportation . 92Definition .92Service Components .92Limitations/Exclusions .92Certification/Provider Qualifications.93Roles Related to a Participant’s Access to Non-Medical Transportation .93Appendices . 96Appendix A: Glossary of Key Terms . 96Appendix B: HCBS Settings Overview. 103Appendix C: Person-Centered Planning Guidance . 107Appendix D: Utilization Management/Medical Necessity Guidelines for Children’s Aligned Home andCommunity Based Services . 108Appendix E: Prior/Concurrent Authorization Grid . 109Appendix F: Table of Responsibilities for HCBS Workflow. 112Appendix G: HCBS Plan of Care Workflow . 113Step 1: Referral to Identified HCBS Providers and Services .113Step 2: Establishment of First Appointment and Notification to the MMCP (if the child/youthis not enrolled in a MMCP, skip this step).115Step 3: Authorization of Requested/Continued HCBS and Care Manager Notification .115Step 4: Development, Updating, and Distribution of the POC.119Referrals for HCBS .121Updating the Plan of Care .122Individuals who are Ineligible for or Decline Children’s HCBS .122Appendix H: Community Habilitation Guidelines . 124Appendix I: Training Grid . 129Appendix J: Policy and Webinar Grid . 131Appendix K: Service Animal Guidance . 132VERSION 2022-1MAY 2022PAGE 6

Children’s Home and Community Based Services (HCBS) ManualAppendix L: Medicaid Eligibility Guidance . 136Medicaid Eligibility Status Impact on HCBS Eligible Children .136Process for Renewing and Establishing Medicaid for Children’s Waiver Participants .141Medicaid Excess/Surplus Income (Spenddown) Program Guidance for Children’s CareManagement and Home and Community Based Services (HCBS) .143Appendix M: HCBS LOC Eligibility Guidance . 146Care Management Requirements for HCBS Eligible Children .146Requirements Regarding the Children’s Waiver Home and Community Based Services(HCBS) Participants Placed in a Restricted Setting .149HCBS Determination for Children Discharging from OMH Residential Treatment Facility orPsychiatric Center .150Appendix N: Health Home Serving Children Policy Information . 156Appendix O: Billing and Claiming Resources . 157Appendix P:Waiver Performance Measures . 158APPENDIX Q: K-CODES RR/E FOR THE CHILDREN’S WAIVER . 161VERSION 2022-1MAY 2022PAGE 7

Children’s Home and Community Based Services (HCBS) ManualINTRODUCTIONHome and Community Based Services (HCBS) are designed to allow children andyouth to participate in developmentally and culturally appropriate services throughMedicaid. New York State (NYS) is committed to serving individuals in the leastrestrictive environment possible by providing services and supports to children/youthand their families at home and in the community. HCBS are designed for children/youthwho, if not receiving these services, would require the level of care provided in a morerestrictive environment such as a long-term care facility or psychiatric inpatient care andfor those at risk of elevating to that level of care.The Children’s Medicaid System Transformation for individuals under the age of 21includes the alignment of the following NYS children’s waivers previously accessibleunder the authority of the 1915(c) amendment of the Federal Social Security Act: Officeof Children and Family Services (OCFS) Bridges to Health (B2H) Serious EmotionalDisturbance (SED), B2H Developmental Disabilities (DD), B2H Medically Fragile(MedF), the Office of Mental Health (OMH) SED Waiver, Office for People WithDevelopmental Disabilities (OPWDD) Care at Home (CAH) IV Waiver, and theDepartment of Health (DOH) operated Care at Home (CAH) I/II Waiver.The Office of Addiction Services and Supports (OASAS), OCFS, OMH, OPWDD, andDOH have collaborated to create an aligned service array of HCBS benefits for childrenmeeting specific diagnostic and functional criteria. The new 1915(c) Children’s Waiverand 1115 Medicaid Redesign Team (MRT) Waiver, with approval from the Centers forMedicare and Medicaid Services (CMS), provides NYS the authority for these HCBSbenefits. The waiver includes person-centered planning requirements (see Appendix C)and specifies transitional coverage requirements for children/youth enrolled in any of theaforementioned 1915(c) waivers at the time of transition.HCBS eligibility includes:1) target criteria,2) risk factors,3) functional criteria, and4) Medicaid eligibility.VERSION 2022-1MAY 2022PAGE 8

Children’s Home and Community Based Services (HCBS) ManualThis manual defines the specific composition of each service while outlining providerroles and responsibilities and is a reference tool for Health Homes (HH), Health HomeCare Managers (HHCM), HCBS Providers, Medicaid Managed Care Plans (MMCPs),and the State’s Independent Entity of Children and Youth Evaluation Services (C-YES)for care management and/or assist with the determination of Medicaid eligibility. AllHCBS benefits are applicable in any home or community setting meeting federal HCBSsettings requirements (see Appendix B) inclusive of the child or family environment, withsome exceptions noted in this manual.This manual also provides an outline of performance measures that are pertinent to theHHCM/C-YES and HCBS Providers (see Appendix P). The performance measuresnoted in the Appendix P are not inclusive of all performance measures required by theChildren’s Waiver. For a full list of all required reporting measures, please see the1915(c) Children’s Waiver.VISION AND GOALSHCBS are designed to offer support and services to children/youth in noninstitutionalized settings that enable them to remain at home and in the community orfor children/youth being discharged from an institutional setting who require theseservices to safely return to their home and community. HCBS provides a family-driven,youth-guided, culturally and linguistically appropriate system of care that accounts forthe strengths, preferences, and needs of the individual, as well as the desired outcome.Services are individualized to meet the physical health, developmental, and behavioralhealth needs of each child/youth. Participants have independent choice among an arrayof service options and providers. These services are provided in a flexible,complimentary package that evolves over time to meet the changing needs of thechild/youth.HCBS are intended to be provided to a child/youth and family in their home and/or thecommunity. The array of services is intended to assist children/youth in beingsuccessful at home, in school, and in their other natural environments to help maintainthem in their community and avoid higher levels of care and out-of-home placements.It is the mission of NYS and its child and family serving agencies to improve health andbehavioral health care access and outcomes for individuals served while demonstratingsound stewardship of financial resources.VERSION 2022-1MAY 2022PAGE 9