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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

600.1

Introduction

As a Medicaid Waiver program, services provided through the OMH Children's HCBS Waiver are coded and reimbursed through Medicaid. Billing follows general Medicaid rules as well as rules specific to the HCBS Waiver. Compliance with Medicaid requirements, such as following billing rules and careful documentation, will assist providers in avoiding Medicaid disallowances.

HCBS Waiver billing begins when the child is approved for enrollment through the OMH Operations Support Unit (see chapter 500 for additional information).

To bill for any service, the service, and the purpose of the service in furthering a child’s goal, must be clearly identified in the child’s service plan. Every service must be connected to one of the objectives for the Waiver child in order to bill.

Different Waiver Services have different billing “designs” and are explained in detail in the following sections:

When Billing Can Begin

ICC Agencies must not begin billing for Waiver services until specifically advised to do so by OSU. The notification of the Effective Billing Date is done electronically in a report through CAIRS via the Program Notes screen. The report is the HCBS-Waiver Date Advised to Bill Notices. ICC billing staff must wait for notification via this report advising of the enrollment date before initiating billing. Important Note: Receipt of the Notice of Decision - Acceptance form is not to be interpreted as an instruction to begin billing. Notification via the Effective Billing Date Report is required before billing may begin.

OMH HCBS Children’s Waiver Rate Codes Effective April 1, 2009.

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