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Ann Marie T. Sullivan, M.D., Commissioner
Governor Andrew M. Cuomo

Home and Community Based Services Waiver
Guidance Document
Division of Children and Families

500.7

Transfers: New county and New Provider, New County and Same Provider, Same County and New Provider

Policy

Background

Effective January 1, 1996, the Federal Health Care and Finance Administration (HCFA)1 approved New York’s request to waive the statewideness requirements of Section 1915 (c) of the Social Security Act. Statewideness requirements were waived to allow the implementation of the HCBS Waiver on a demonstration basis in select counties and the five boroughs of New York City.

Since 1996, the HCBS Waiver has grown in capacity and expanded to other counties. With the expansion of the Waiver in 2005-06, it is now active in all but one (i.e. Oneida) of New York's 62 counties. Now that the Waiver is accessible on a statewide basis, CMS requires that when a child moves from one county to another county they remain eligible for the Waiver and must be provided with services in the new county if still needed/desired.  As a result, the following procedures have been developed for handling transfer cases, including allowing a program/county to temporarily exceed capacity when a waiver child moves to their county and they are already at capacity.

Procedures

Situation 1: Family/child moves to new county; requires transfer to new provider.

Who Action(s)
Family Notify current (i.e. sending) ICC agency of intent to move and expected timeframes.
Sending ICC Agency Within 4-6 weeks prior to the expected move date, contact receiving ICC agency to advise that you have a child that will be moving to their county and needs to be transferred to their program. Provide the anticipated move date.
Receiving ICC Agency Determine if a vacancy will be available at  time of anticipated move/transfer.
  • If vacancy is expected and there is no wait list, then earmark vacancy for transfer. There should be no need to go over census in this situation.
  • If no vacancy is expected at the time of the transfer your program will have to accept the child when s/he transfers and exceed approved capacity until the next vacancy occurs.
Note: When a county is over capacity the expectation is that the ICC caseload ratio of 1:6 will increase to 1:7 or the Supervisor will pick up the additional case until the census returns to the allocated slot capacity.
Sending ICC Agency Monitor family’s move status.  Once move happens: Make a copy of entire case record and complete HCBS Transfer - Case Record Transmittal Cover Memo. Send copy of case record and original of the HCBS Transfer - Case Record Transmittal Cover  Memo to the receiving ICC in accordance with HIPAA requirements. Retain original case record and copy of the Case Record Transmittal Cover Memo at your agency. Send copies of the Case Record Transmittal Cover Memo to sending LGU and OSU.
Receiving ICC Agency Complete Part 1 of  the HCBS Transfer - Exceeding Capacity Turnaround Form. Send original to CO Children and Families (attention: Gary Hook), with a copy to ICC file.
CO C&F Annotate Census Capacity Log.
Receiving ICC
  • Complete the HCBS Transfer - Notification of Transfer Form -ICC check box #1. Send original to OSU, with copies to sending ICC, receiving LGU, sending LDSS, and child/family.
  • Note: Obtain address for former LDSS from the HCBS Transfer - Case Record Transmittal Cover  Memo received from the sending ICC.
  • Upon receipt of case record, contact family and make appointment to review child’s existing Service Plan and to complete a Medicaid application, if necessary.
  • Meet with family. Review Service Plan and revise if necessary. Complete Medicaid application, if necessary, and gather required documentation.
  • Once Medicaid application is completed, complete the HCBS Transfer - Cover Letter for Medicaid Application.
  • Send/deliver the original cover letter and application package to the receiving LDSS. Mail a copy of the application and cover letter to OSU. Note: Copies of any documentation included with the application are not required by OSU.
  • In the event that the family has already filed a Medicaid application with the new county, send the HCBS Transfer -Letter to LDSS Confirming Clinical Eligibility for Waiver to the new LDSS. Besides confirming the child’s clinical and fiscal eligibility for the OMH HCBS Waiver, it reminds the LDSS of the special budgeting rules for the OMH HCBS Waiver.
OSU
  • Annotate HCBS Waiver Roster to show that child’s case at sending ICC is terminated and that new case is opened at receiving ICC.
    • Assign new case number (i.e. new program/new county/new consecutive number) for new case at receiving ICC and annotate both entries to reflect transfer status. Note: See Roster Update procedures for detailed procedures re. proper annotation method.
  • Monitor case on WMS to ensure that Medicaid is closed in the old LDSS and opened in the new LDSS in timely manner.
  • Monitor case in WMS to ensure that the proper S/F code is added to the new LDSS case.
Receiving ICC Agency As soon as the next vacancy occurs, annotate Part 2 of  the copy of the HCBS Transfer - Exceeding Capacity Turnaround Form in the file folder. Send the original to CO C&F (attention: Gary Hook) and retain copy in file.
CO C&F Annotate Census Capacity Log.

Following are the actions that we anticipate that the Local Medicaid Offices (LDSSs) will take in this situation:

Who Action(s)
LDSS Existing Upon receipt of the information re. the date of the move, close child’s MA case effective the last day of the month following the month of the move.
  • Note: In some cases when sending LDSS closes its case coverage may continue beyond the last day of the month following the month of the move until the receiving county opens their case at which time the system may adjust the sending county’s end date (this is known as Continuous Save Date policy.)
Issue Notice of Termination to child/family, copy to OSU.
LDSS - Receiving
  • Open  Medicaid case for child effective the first of the month Receiving of the application is filed with them -or- effective the day the former LDSS’s case closed, whichever is later.
  • Add appropriate S/F charge indicator.
  • Issue Notice of Decision to child/family, copy to OSU.
Note: In order to ensure that there is no gap in Medicaid coverage that will prevent them from receiving full reimbursement, the receiving ICC is responsible for monitoring Medicaid application process to ensure that the application is filed in a timely manner, i.e. no later than the month that the old LDSS’s coverage expires.

Situation 2:  Family/child moves to a new county; remains with same ICC agency.

Who Action(s)
Family Notify existing ICC agency of intent to move and expected timeframes.
Existing ICC Agency Monitor status of move. Once move to the new county occurs, if there is no simultaneous termination taking place, then it is necessary to exceed capacity until the next termination occurs. Note: When a county is over capacity the expectation is that the ICC caseload ratio of 1:6 will increase to 1:7 or the Supervisor will pick up the additional case until the census returns to the allocated slot capacity. Complete Part 1 of  the HCBS Transfer - Exceeding Capacity Turnaround Form. Send original to CO Children and Families (attention: Gary Hook), with a copy to ICC file.
CO C&F Annotate Census Capacity Log.
Existing ICC Agency
  • ICC worker in new county contacts family and makes appointment for review/revision of child’s existing service plan and completion of a Medicaid application, if necessary.
  • Complete the HCBS Transfer - Notification of Transfer Form -check box #2. Send original of form to OSU, copies to sending LDSS, receiving LGU and child/family.
  • Meet with family. Review service plan and budget; revise if necessary. Complete Medicaid application and gather required documentation, if necessary.
  • Once Medicaid application is completed, complete the HCBS Transfer - Cover Letter for Medicaid Application. Send/deliver the original cover letter and application package to the receiving LDSS. Mail a copy of the application and cover letter to OSU. Note: Copies of any documentation included with the application are not required by OSU.
In the event that the family has already filed a Medicaid application with the new LDSS, send the HCBS Transfer -Letter to LDSS Confirming Clinical Eligibility for Waiver to the new LDSS. Besides confirming the child’s clinical and fiscal eligibility for the OMH HCBS Waiver, it reminds the LDSS of the special budgeting rules for the OMH HCBS Waiver.
OSU Annotate HCBS Waiver Roster to reflect child’s transfer to the new county, i.e:
  • Assign new case number (i.e. old program/new county/new consecutive number) for new case at receiving ICC and annotate both entries to reflect transfer status. Note: See Roster Update procedures for detailed procedures re. proper annotation method.
Monitor case on WMS to ensure that Medicaid is closed in the old LDSS and opened in the new LDSS in timely manner.

Monitor case in WMS to ensure that the proper S/F code is added to the new LDSS case.
Existing ICC Agency Once the next child is terminated from Waiver, annotate Part 2 of the copy of the HCBS Transfer - Exceeding Capacity Turnaround Form in the file folder. Send the original to CO C&F (attention: Gary Hook) and retain copy in file.
CO C&F Annotate Census Capacity Log.

Following are the actions that we anticipate that the Local Medicaid Offices (LDSSs) will take in this situation:

Who Action(s)
LDSS Existing Upon receipt of the information re. the date of the move, close child’s MA case effective the last day of the month following the month of the move.
  • Note: In some cases when sending LDSS closes its case coverage may continue beyond the last day of the month following the month of the move until the receiving county opens their case at which time the system may adjust the sending county’s end date (this is known as Continuous Save Date policy.)
Issue Notice of Termination to child/family, copy to OSU.
LDSS - Receiving
  • Open  Medicaid case for child effective the first of the month of the application is filed with them -or- effective the day the former LDSS’s case closed, whichever is later.
  • Add appropriate S/F charge indicator.
  • Issue Notice of Decision to child/family, copy to OSU.
Note: In order to ensure that there is no gap in Medicaid coverage that will prevent them from receiving full reimbursement, the ICC is responsible for monitoring Medicaid application process to ensure that the application is filed in a timely manner, i.e. no later than the month that the old LDSS’s coverage expires.

Situation 3: Family/child remains in same county; transfers to new ICC Agency.

Note: This can only happen in NYC and in counties where there is more than one ICC Agency in operation, i.e. Erie and Westchester.

Who Action(s)
Family Notify existing (i.e. sending) ICC agency of intent to move/transfer and expected timeframes.
Sending ICC Agency Within 4-6 weeks prior to the expected move/transfer date, contact receiving ICC agency to advise that you have a child that will need to be transferred to their program. Provide the anticipated move date.
Receiving ICC Agency Determine if a vacancy will be available at time of anticipated move/transfer.
  • If vacancy is expected and there is no wait list, then earmark vacancy for transfer. There should be no need to go over census in this situation.
  • If no vacancy is expected at the time of the transfer your program will have to accept the child when s/he transfers and exceed approved capacity until the next vacancy occurs.
Note: When a county is over capacity the expectation is that the ICC caseload ratio of 1:6 will increase to 1:7 or the Supervisor will pick up the additional case until the census returns to the allocated slot capacity.
Sending ICC Agency Monitor family’s move status.  Once move happens:
  • Make a copy of entire case record and complete HCBS Transfer - Case Record Transmittal Cover Memo.
  • Send copy of case record and original of the HCBS Transfer - Case Record Transmittal Cover  Memo to the receiving ICC in accordance with HIPAA requirements. Retain original case record and copy of the Case Record Transmittal Cover  Memo at your agency. Send copies of the Case Record Transmittal Cover Memo to sending LGU and OSU.
Receiving ICC Agency Complete Part 1 of  the HCBS Transfer - Exceeding Capacity Turnaround Form. Send original to CO Children and Families (attention: Gary Hook), with a copy to ICC.
CO (C&F) Annotate Census Capacity Log.
Receiving ICC Agency
  • Complete the HCBS Transfer - Notification of Transfer Form ) - check box #1. Send original of form to OSU, with copies to sending ICC, receiving LGU, and child/family.
  • Upon receipt of case record, contact family and make appointment to review child’s existing Service Plan.
  • Meet with family. Review Service Plan and revise if necessary.
OSU Annotate HCBS Waiver Roster to show that child’s case at sending ICC is terminated and that new case is opened at receiving ICC.
  • Assign new case number (i.e. new program/old county/new consecutive number) for new case at receiving ICC and annotate both entries to reflect transfer status.
Note: See Roster Update procedures for detailed procedures re. proper annotation method.
Receiving ICC Once the next child is terminated from Waiver, annotate part 2 of the copy of the HCBS Transfer - Exceeding Capacity Turnaround Form in the file folder. Send the original to CO C&F (attention: Gary Hook) and retain copy in file.
OSU Annotate Census Capacity Log.

Note: In Situation 3, there is no activity required on the part of the LDSS since the Medicaid eligibility remains in the same county.


  1. Now known as the Centers for Medicare and Medicaid Systems (CMS).

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.