National Guidance from CMS and SAMHSA with Parity Defined for Consumers

The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health and the Substance Abuse & Mental Health Services Administration (SAMHSA) recently released a guidance on how to communicate about social and behavioral health services to consumers. The Roadmap provides clear steps for treatment and recovery with checklists and sample forms to gather information, as well as information on Mental Health and Substance Addiction Parity requirements. Also included in this document is a glossary of terms to explain technical Parity language that may be cumbersome to understand.

Click here to download the Roadmap: https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Coverage-to-Care-Behavioral-Roadmap.pdf

Upcoming Webinar on NYS Children's Medicaid System Transformation

NYS Department of Health (DOH), Office of Alcoholism & Substance Abuse Services (OASAS), Office of Children & Family Services (OCFS), Office of Mental Health (OMH), and Office for People With Developmental Disabilities (OPWDD) will be hosting a joint webinar presentation on Monday, September 18 from 1:00PM to 2:30PM. The webinar will focus on the Medicaid Children's System Transformation. They will provide a refresher course on the key elements of the children's transformation, including timeframes, expansion of services, transition to Medicaid Managed Care, and important readiness activities that providers should be engaged in now. They encourage Health Home leadership, care management agencies, current 1915(c) Waiver providers, applicants for expanded services, and all interested stakeholders to attend.

Click here to register for the Children's Medicaid System Transformation Overview/Refresher.

You can also view our HCBS Consulting Services Overview to learn about how we may be able to assist you in this arena.

Executive Coaching from SAE Now Available!

With changing requirements and opportunities in the service field, a guided approach for development can be helpful. Linking to a coach who understands the service history and also the current demands in service delivery and service outcomes can yield lasting results. Expert coaching is supportive, informative, and personalized.

Expert coaching can help with:

  • identifying opportunities for business growth;
  • developing action plans for challenges;
  • staying updated on moving policies, plans, and requirements; and
  • systematizing operational goals to match service opportunities.

SAE's Executive Coaching services are now available.

Our coaching services include:

  • a termed timeline to engage in scheduled coaching sessions for members of your team;
  • think tank sessions that are focused and informed;
  • services tailored and specialized to the demands, interests, and concerns of your service agency's needs; and
  • developed team action steps to track potential for change and define business goals.

Steven Rabinowitz is a member of our Executive Coaching team. Rabinowitz recently retired after 30 years of service at the NY State Office of Alcoholism and Substance Abuse Services (OASAS), where he spent the last 11 years as the Director of Downstate Field Operations, overseeing funding and program services in NYC and Long Island for over 250 substance abuse prevention, treatment, recovery, and specialized services provider agencies. Besides his thorough knowledge of fiscal, programmatic, and operational issues facing provider agencies, Steve was heavily involved for the last few years with initiatives like managed care, health homes, DSRIP, HCBS, and Value-Based Payments, as well as serving as co-leader of a major internal reorganization effort within OASAS.

For more information on how to benefit from SAE's Executive Coaching services, you can email info@saeassociates.com or call (212) 684-4480.

CMS to Cancel Mandatory Cardiac, Expanded Joint Replacement Bundles

Earlier this month, the Centers for Medicare and Medicaid (CMS) proposed a rule to the Office of Management and Budget that would stop programs scheduled to launch January 2018. Both cardiac and joint replacement programs were proposed just over a year ago, with an original launch date of July 2017 and were previously delayed. CMS may issue a new rule to continue the Bundled Payments for Care Improvement (BPCI) initiative, a voluntary program that had been scheduled to end in 2018. The new version of BPCI may allow qualification as an Advanced Alternative Payment Model (APM) under the Medicare Access and CHIP Reauthorization Act (MACRA).

Value-Based Bundle Payment Models must be tied to health analytics that use risk stratification and population health metrics. Feel free to email info@saeassociates.com for more information. 

Does your agency have a value statement?

A Value-Based Payment (VBP) initiative can be an opportunity to restructure and grow. With careful planning, an analysis of outcome metrics and risk, transformation to new service models, and readiness to capture responsiveness to value measures, VBP can help in formalizing treatment practice and developing innovative, cost-effective care.

Whether your agency is preparing to be a lead, be a network provider or be a linkage partner, having a salient value statement is essential. It must address key strengths, opportunities, outcomes, risks and responsibilities. It must be versatile as well as specific in citing relevant impact on cost of care and alignment with population risk variables.

Email info@saeassociates.com to learn about how to build your value statement.

Mental Health Parity under the ACA and Cures Act

The 21st Century Cures Act, signed by President Obama on December 13, 2016, requires the Department of Labor, the Treasury, and Health and Human Services to solicit public responses and feedback on how to improve disclosures of health plan benefits in compliance with the Mental Health Parity & Addiction Equity Act of 2008 (MHPAEA).

In Section 13007 of the Cures Act, coverage for eating disorder benefits must be consistent with the requirements of MHPAEA.

The Departments' recent FAQ, released in June, defines eating disorder as a mental health condition and is requesting public comment on how MHPAEA apply to the treatment of Eating Disorders.

SAE understands the administrative and clinical complexity of eating disorder treatment. Professional services, such as nutrition services, need to be part of an outpatient team approach. However, essential components for eating disorder treatment or the continuum of treatment care have not always been approved for eating disorder patients. Additionally, "medical necessity" determinations should not be ascertained by weight only; indeed, clinical criteria for varying levels of care determinations need to be inclusive of psychiatric functional assessment. Otherwise, there are inherent concerns of non-quantitative treatment limitations (NQTLs). 

SAE will be submitting a public comment for the Departments. 

All comments to the Departments about eating disorders are due September 13, 2017 to:

e-ohpsca-mhpaea-eating-disorders@dol.gov.

NYS Develops Draft Transition Plan for the Children's Medicaid System Transformation

New York State has developed a DRAFT Transition Plan for the Children's Medicaid System Transformation. The draft Transition plan (subject to approval by Centers for Medicare & Medicaid Services) is being shared with interested stakeholders for review and comment.

Comments are due August 31, 2017 by email to BH.Transition@health.ny.gov, with the subject line: "Draft Children's Transition Plan Comments". In your comments, indicate the section and page number to which your comment refers to.

The State will also hold a statewide webinar on August 24, 2017 at 3PM to review the Draft Transition Plan in detail to assist stakeholders. You can register for the webinar here: 

https://attendee.gotowebinar.com/register/2231325092871212547.

Update for New York HCBS Providers

Children Provider Applicant for HCBS and SPA

Applications for Children HCBS and SPA were due July 31. Designation letters to providers are expected in October. 

Contracting, credentialing, and claims testing may take up to nine months. The list of designated providers will be used by Medicaid Managed Care plans to develop networks for service provision expected to begin July 1, 2018. 

Adult HCBS Providers

New York State received approval from the Centers for Medicare & Medicaid Services (CMS) to increase rates retroactively for several Behavioral Health Home and Community Based Services (BH HCBS) covered by the Health and Recovery Plan (HARP) and HIV Special Need Plans (HIV SNP). 

Start-up fees have increased by 50% of the currently approved fee. 

 

The rate increases have been posted.

Attestation of Readiness Form from OMH and OASAS will be sent to all providers in Western New York, Central New York, Hudson River, and Long Island. Check the Provider Designation List to see if you are a recognized Adult HCBS provider and verify your contact information. Providers who are on "hiatus" for Adult HCBS may email their current updated contact information to omh.sm.co.hcbs-application@omh.ny.gov

Contact SAE for assistance with any financial modeling, service launches, or assistance with the Attestation of Readiness Form. Email info@saeassociates.com or call (212) 684-4480. 

Provider Applications for HCBS/SPA Waiver Services Should Be Submitted at the End of July

As you may know by now, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS), Department of Health, Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and Office for People With Developmental Disabilities (OPWDD) recently announced the re-release of the Children´s State Plan (SPA) / Home and Community Based Services (HCBS) Provider Designation Application. 

To view the full announcement from CTAC, click here.

Prep your staff on the clinical designation for Children HCBS services.

Eligibility requirements: 

  • Must be between 5 and 17 years of age, if enrolled prior to 18th birthday may remain in the Waiver up to the age of 21.
  • Have serious emotional disturbances.
  • Demonstrate complex health and mental health needs.
  • Require or be at imminent risk of needing psychiatric inpatient care.
  • Service and support needs cannot be met by one agency/system.
  • Have a consistent and viable living arrangement with family that is able and willing to participate in the waiver.
  • Appear to be capable of being cared for in the community with access to waiver services.
  • Be eligible for Medicaid; and
  • Parental income and resources are not considered when determining the child's eligibility for Medicaid.

NYS advises current system providers to submit designation application by July 31, 2017.

If you would like to explore how we can help you in this arena, email info@saeassociates.com or call (212) 684-4480. 

UPDATE: NYS Re-Releases Children's SPA/HCBS Provider Designation Application

The New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS), Department of Health, Office of Mental Health (OMH), Office of Children and Family Services (OCFS), and Office for People With Developmental Disabilities (OPWDD) have announced the re-release of the Children´s State Plan (SPA) / Home and Community Based Services (HCBS) Provider Designation Application. 

The following information is directly from the Community Technical Assistance Center of New York (CTAC).

Beginning July 1, 2018, providers must be designated through this process to provide newly aligned Children's SPA/HCBS services under the NYS Medicaid program (including both fee-for-service Medicaid and Medicaid Managed Care):

  • SPA: Other Licensed Practitioner, Community Psychiatric Supports and Treatment, Crisis Intervention, Psychosocial Rehabilitation, Family Peer Support Services, Youth Peer Support and Training.
  • HCBS: Caregiver Family Supports and Services, Habilitative Skill Building, Planned Respite, Crisis Respite, Supported Employment, Community Self-Advocacy Training and Support, Habilitation, Palliative Care, Prevocational Services.

Timeframes:

  • State Agency Partners will prioritize reviews of applications from current 1915(c) waiver providers beginning in July 2017.
  • NYS anticipates sending out designation letters to current system providers in October 2017.
  • Lists of designated providers will be posted online. This list will be utilized by Medicaid Managed Care Plans to develop networks for service provision that begins on July 1, 2018.
  • The application was revised on June 14, 2017 to include additional questions.

**For applications that were submitted before the June 14 modification date, resubmission is not necessary. An email notification will be sent by NYS requesting additional information.

NYS advises current system providers to submit designation application by July 31, 2017. Contracting, credentialing, and claims testing typically take approximately nine months in total. Delays in submission of the application to NYS may result in delay dependent contracting, credentialing, and claims testing work, and could affect network status 

The designation application is available at: https://my.omh.ny.gov/hcbs/default.aspx.

To view the full announcement from CTAC, click here.

If you would like to explore how we can help you in this arena, email info@saeassociates.com or call (212) 684-4480. 

Helping You Adjust to the Managed Care Environment

Although behavioral health Parity has been required of insurers and managed care organizations for the better part of the past 10 years, there is substantial evidence that payers have not fully implemented policies and practices consistent with parity requirements. Since 2014, SAE has functioned as an external Parity compliance administrator in NYS monitoring the progress of a health plan and its behavioral health vendor in meeting the terms of a legal settlement set by the NYS Attorney General to become Parity compliant according to the Federal Legislative Act of 2008.

In doing so, SAE has acquired the insight into the managed care utilization review process as well as the data metrics to develop an aggressive utilization review process and institutional process, and a data metrics platform to help you gain control over the claims submission process and increase your revenue. In addition, we can offer trainings that address your concerns, such as:

  • How do you launch a successful request for authorization of services?
  • How do you frame successful appeals?
  • How do you determine whether a denial is appropriate?
  • What kind of data is necessary to monitor claims denial and appeals processes?
  • What kind of data should you be developing to prepare for value-based payments?

The Parity team at SAE is available to discuss our approach, and to answer any questions you may have about how we can support your efforts to address the fiscal issues in behavioral health imposed by the emergence of managed care contracting. To do so, please contact SAE at (212)-684-4480 or email info@saeassociates.com

 

SAE Parity Podcast Series: click here

SAE Webinar, hosted by the Hospital Association of NYS: click here

 

 

 

Funding Increases in DOH's Data Exchange Incentive Program

The New York eHEalth Collaborative recently announced some changes that have been made to the Data Exchange Incentive Program (DEIP). See below for details, directly from a recent NYeC announcement:

The New York State Department of Health (NYS DOH) and the Centers for Medicare Medicaid Services (CMS) established the DEIP to increase the adoption of Health Information Exchange (HIE) across the state. Building Electronic Health Record (EHR) interfaces to Qualified Entities (QEs) will increase the quantity and quality of data in the Statewide Health Information Network for New York (SHIN-NY) and build value for providers and patients at the point of care. This program is designed to help defray the cost for an organization when connecting to a QE by incentivizing the contribution of a pre-defined set of data elements. NYeC coordinates the program and the incentive payments on behalf of the NYS DOH.

An additional change to the program relates specifically to Medicare and Medicaid Eligible Professionals (EPs). NYeC and NYS DOH are sunsetting the additional $500 per EP portion of the program's incentive*. The increase in the standard Milestone 2 payment is intended to help offset the elimination of the $500 per EP. Lastly, the data contribution requirements for organizations with Medicare or Medicaid EPs has been streamlined to be consistent with the requirement for most other DEIP-eligible organizations. EPs participating in the program shall now contribute the common clinical data set in C-CDA format, as the data is available and appropriate.

The new potential incentive for eligible healthcare organizations to connect to the SHIN-NY through DEIP is $13,000 per organization. 

SAE can help you address your IT needs so you can be part of data improvement and connectivity.

If you'd like to explore how we can help you in this arena:

email us at info@saeassociates.com or call (212)-684-4480.

NYS Launches Behavioral Health Value Based Payment Readiness Program

*Notifications of Intent are due June 16, 2017.

The New York State Office of Mental Health (OMH) and Office of Alcoholism and Substance Abuse Services (OASAS) have announced the launch of the NYS Behavioral Health Value Based Payment Readiness Program. OASAS and OMH expect that the program will prime behavioral health providers to be successful in the State's transformation of the health care delivery system.

OMH and OASAS are currently accepting Notifications of Interest from behavioral health providers that are interested in the program. 

The following is directly from the OMH website:

The program will fund BH providers to collaborate to form Behavioral Health Care Collaboratives (BHCC), including Independent Practice Associations (IPAs), in an effort to position them to succeed in the VBP environment. There will be funds available for planning, and a larger funding opportunity for implementing a BHCC. Funding will support the development of shared infrastructure for the BHCC, such as clinical quality standards, data collection, analytics, and reporting. The expectation is that BHCCs will leverage their shared expertise to better position themselves to enter into VBP contracts. Proposed BHCCs intending to apply must submit a Notification of Interest no later than June 16, 2017

The Notification of Interest Form:

https://www.omh.ny.gov/omhweb/bho/notification_of_interest.pdf 

Do you have an OMIG headache?

Preparing to contest OMIG's final analysis of your case reviews is a daunting task and if not thoroughly conducted, it can cost your organization money. And in many cases, a lot of money!

SAE & Associates has the capacity and experience to standardize the OMIG protocol into a score sheet to review case records (in both written and electronic formats) according to reported deficiencies. Using a team of experienced clinical case record reviewers, SAE experts review chart content using these standard protocols while also determining whether additional documentation provided by the organization during the appeal process changes the final analysis.

By connecting solutions of the clinical, administrative, and technology elements for future OMIG audits, SAE is able to identify unlabeled EHR content, conduct data dives, identify failure trends, and provide corrective action plans for effective process and practice change.

SAE & Associates can provide your organization with concrete data for your OMIG appeal process and customized plans to prevent future unfavorable OMIG results.

If your OMIG audit final analysis is giving you a headache and you're looking for a way to contest the results, SAE & Associates can help you make your case.

More information on SAE's OMIG Audit Support and Appeals:

http://saeandassociates.com/behavioral-health-regulatory-compliance-and-licensing/ 

CMS Announces Extension for Transitioning to the HCBS Model

Yesterday, the Centers for Medicare & Medicaid Services (CMS) posted an informational bulletin on its website with an update on home and community-based services (HCBS). According to the released statement, CMS is extending the transition period for states to demonstrate compliance with the HCBS criteria until March 2022. CMS expects that the three additional years will give states enough time to fully transition to the HCBS model.

To view the full informational bulletin, click the following link:

https://www.medicaid.gov/federal-policy-guidance/downloads/cib050917.pdf

SAE Announces Its Substance Use Disorder Team of Experts!

In response to the challenges facing substance use treatment providers, SAE & Associates is pleased to announce its specialized Substance Use Disorder Initiative! For our launch, SAE has assembled a team of leading professionals who can assist in maximizing revenue, maintaining regulatory compliance, achieving fiscal efficiency, measuring outcomes and quality of care, and dealing with managed care organizations. Stay tuned, as you will also be hearing from our team as we release resource guidance for operational solutions.

Introducing Our Team

Team Leader Steven Rabinowitz recently retired after 30 years of service at NY State Office of Alcoholism and Substance Abuse Services (OASAS), where he spent the last 11 years as the Director of Downstate Field Operations, overseeing funding and program services in NYC and Long Island for over 250 substance abuse prevention, treatment, recovery and specialized services provider agencies, and supervised 35 staff associates. Besides his thorough knowledge of fiscal, programmatic and operational issues facing provider agencies, Steve was heavily involved for the last few years with initiatives like managed care, health homes, DSRIP, HCBS, Value-Based Payments, as well as serving as co-leader of a major internal reorganization effort within OASAS.

William Panepinto, LMSW, has an over 30-year history of government and consultation experience serving non-profits targeting vulnerable homeless populations and individuals with substance abuse issues. His career has included ten years of treatment experience and 25 years of state government work with OASAS. At OASAS, he brought addiction specialty care to Community Health Centers and NYC Homeless Shelters in the 1980s, and HUD Shelter Plus Care Homeless Permanent Housing grants to NYS communities in the 1990s. Under his leadership as the first Director of Bureau of Housing Services for OASAS from 2007 to 2013, the agency's Housing Portfolio increased from 850 units in NYC and ten other counties, to over 2,200 units in NYC and thirty additional counties. Recently, Bill designed the OASAS New York/New York III Homeless Initiative for Single Adults and for Families, and the OASAS MRT Supportive Housing Initiative.  Since March 2015, he has have worked as the Director of Special Projects, a part-time position for St. Joseph's Addiction Treatment and Recovery Centers. His focus has been on supportive housing, residential redesign, and co-location of primary health care and behavioral health care.

Shelley Scheffler, PhD, LCSW-R, is an early adopter of the theory and practice of integrated care and has dedicated her career to promoting it in different healthcare and treatment settings. As Vice President of Practice Innovations at Services for the UnderServed, she was instrumental in transitioning the organization to an integrated care model with new initiatives such as the Trauma Informed Care Project, including a Zero Suicide effort, and participation in the SAMHSA learning collaborative to integrate primary care into substance use treatment. Prior to this, Dr. Scheffler was the Senior Integrated Care Specialist at the Center for Excellence in Integrated Care (CEIC), a project was funded by the New York State Health Foundation to promote co-occurring capability in substance use and mental health treatment services throughout New York State. Dr. Scheffler has also provided technical assistance to FQHC's, providing organizational training and detailed outcome analysis. In her career, she has had administrative experience leading case management and substance use services at a large hospital center. She has developed workshops on trauma, substance use, homelessness as well as other social issue topics. Dr. Scheffler has taught at the NYU Silver School of Social Work, the Simmons School of Social Work and the Fordham University CASAC Program.

John Sheehan, LMSW, has focused his 35 + year career serving the substance use and homeless populations including adolescents. Starting his career as an outreach worker, Mr. Sheehan held the position of Vice President at Phoenix House and has held leadership roles at Project Samaritan, Outreach Project, and Bowery Residents Committee, where he served as Deputy Executive Director overseeing Programs for the Homeless Mentally Ill and Chemically Dependent. In addition to his consultant work with SAE & Associates, John has worked with All Souls Church and the 5th Avenue Presbyterian Church to develop social services programs for the homeless. Mr. Sheehan has been honored for his dedication by Phoenix House Foundation and does extensive volunteer work for the MS Society. He is a graduate of Adelphi University with both a Bachelors Degree and Masters Degree in Social Work. He has a Certificate in Non-profit Management from NYU Robert Wagner School. He also has completed trainings recently in Mindfulness and PTSD.

Bruce G. Trigg, MD, is a public health physician who worked for 23 years with the New Mexico Department of Health, where he was the medical director for the Sexually Transmitted Disease (STD) Program. He led the effort to implement a public health and methadone maintenance program at the Bernalillo County Metropolitan Detention Center in Albuquerque. Dr. Trigg helped to develop and expand the statewide harm reduction program, including a needle and syringe exchange program, buprenorphine treatment, and overdose prevention with provision of naloxone. Since retiring from the Department of Health in 2011, Dr. Trigg has been the medical director for Opioid Treatment Programs in New Mexico. He has worked with the University of New Mexico ECHO (Extension for Community Healthcare Outcomes) Program, a collaborative model of medical education and care management, and was on the faculty for physician buprenorphine waiver trainings. 

For more information about how we can help with the expertise you need:

Call (212)-684-4480 or email us at: info@saeassociates.com.

Establishing a Collaborative Support System for Children and Families in New York

According to the New York State Office of Mental Health (OMH), data shows that children with a serious emotional disturbance are more likely to reach optimal development when supported in their home and community environment. To ensure New York's children and families have access to the essential services, the HCBS Waiver demands a collaborative support system involving the family, treatment providers, core waiver services, and other natural supports.

The following information is from the NYS OMH website, which clearly defines the goals of the HCBS Waiver for children. 

The goals of the HCBS Waiver are:

  • to serve children with complex and significant mental health needs in their homes and communities;
  • to decrease the need for placements in psychiatric inpatient levels of care, including Residential Treatment Facilities;
  • to increase the array of Medicaid reimbursable community-based services available to children and adolescents with serious emotional disturbance and their families;
  • to use a culturally sensitive, individualized, strength-based approach to build resiliency, assist in the achievement of age-related developmental tasks, and promote emotional well-being;
  • to provide the services and supports that are specifically needed by each unique family to develop the ability to care for the child in their home in a supportive environment;
  • to offer children and families a choice of providers, when possible;
  • to provide services that promote better outcomes that are also cost-effective; and
  • to demonstrate an integrated model of partnership with the family, treatment provider, core waiver services, and other natural supports that are involved with the child and family.

Click the following link to see OMH's HCBS Guidance Document in its entirety:

https://www.omh.ny.gov/omhweb/guidance/hcbs/html/section_100_1.htm.

Feel free to contact us by emailing info@saeassociates.com, or by calling (212)-684-4480 to explore how we can help you in this arena.

HANYS Hosts SAE's Webinar Addressing the Mental Health Parity Act!

On April 5, the Healthcare Association of New York State (HANYS) hosted a Webinar presented by SAE & Associates titled: Mental Health Parity and Addiction Equity Act (MHPAEA): Improving Patient Care & the Bottom Line! During the presentation, SAE's Independent Compliance Administrator (ICA) team provides a brief overview of MHPAEA, reviews UM/UR practices and identifies key metrics for tracking payer patterns for level of care determinations, and also focuses on how parity rules may improve patient care and the bottom line.

Since the live webinar, we have UPDATED some of the content of the PowerPoint for public view. Click the following link to see the slides: 

http://saeandassociates.com/s/SAE-Hospital-Healthcare-Assoc-Presentation-4617.pdf

Click the following link to view the webinar:

https://hanys.adobeconnect.com/p7x1xhyfnwj/

(if you do not have Adobe Connect, you will be prompted to the quick download of the application)

For more information on how we can help you in this arena:

call (212)-684-4480 or email us at info@saeassociates.com.

Update for NYS HBCS Providers: the Community Mental Health Assessment Billing Policy

New York State recently provided an update on the Community Mental Health Billing Policy.

"Care Management Agencies (CMA) will bill NYS Medicaid directly through the eMedNY system. This process will be used for newly and previously completed assessments for individuals enrolled in Health and Recovery Plan (HARP) or HARP-eligible individuals enrolled in HIV Special Needs Plans. For dates of service beginning October 1, 2015, in New York City and July 1, 2016, throughout the rest of NYS, claims for unpaid assessments completed for these enrolled individuals can be directly submitted to eMedNY. This will be the process until direct billing to Medicaid Managed Care Organizations (MMCO) is implemented, targeted to begin Fall 2017. "

Click the following link to see the update:

http://ctacny.org/sites/default/files/CMHA%20EMedNY%20Policy%20Guidance%20FINAL.pdf

Remember, in order to bill for "BH HCBS Eligibility Assessment or the Community Mental Health Assessment (CMHA) for a HARP flagged individual, the Assessor must verify the individual is enrolled in a HARP through EPACES/EMEDNY." 

See the full procedure on the NYS Department of Health website: https://www.health.ny.gov/.

Stay connected as policy shifts to support practice for these services. SAE remains committed to providers and helping with service shifts toward the realization of the Medicaid Redesign.

 

Do you know the criteria for a child's eligibility for HCBS?

The following is from the New York State Office of Mental Health (OMH) website, which clearly defines the target population of the HCBS Waiver for children. 

The target population for the HCBS Waiver is children/adolescents:

  • with serious emotional disturbance,
  • between the ages of 5 and 17 years (prior to 18th birthday),
  • who demonstrate complex health and mental health needs,
  • who are at imminent risk of admission to a psychiatric institutional level of care or have a need for continued psychiatric hospitalization, 
  • whose service and support needs cannot be met by just one agency/system,
  • who are capable of being cared for in the home and/or community if services are provided,
  • who have a viable and consistent living environment with parents/guardians who are able and willing to participate in the HCBS Waiver, and
  • who can reasonably be expected to be served under the HCBS Waiver at a cost which does not exceed that of psychiatric institutional care.

They must be eligible for Medicaid under the HCBS Waiver (i.e., are currently enrolled in Medicaid or could be enrolled by meeting federal eligibility standards) in a county with an HCBS Waiver program and be capable of being served in the community at or below the federally approved average yearly cost which is adjusted periodically.

Click the following link to see OMH's HCBS Guidance Document in its entirety: 
https://www.omh.ny.gov/omhweb/guidance/hcbs/html/section_100_1.htm

SAE's financial modeling service can help determine risk and ramp up of these new services based upon your agency's current service populations and activities. To learn more about this support service product, check out our recent announcement here: http://saeandassociates.com/announcements/2017/4/5/financial-guidance-for-hcbs-children-providers