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Office of Mental Health

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

Request For Services for Subcontractors

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New York State received federal approval to begin implementation of the Office of Mental Health's Home and Community-Based Services (HCBS) Waiver for Children and Adolescents with Serious Emotional Disturbance on January 1, 1996.  The HCBS Waiver program will expand the funding and service options currently available to the target population and will provide an opportunity to use the Individualized Care framework.  This document provides the background for the HCBS Waiver program's goals, processes and services as well as criteria for potential subcontractors.

The (insert name of LGU) is seeking providers who are interested in delivering one or more of the waiver services other than Individual Care Coordination.   Responses are due by (due date). A provider may indicate an interest in providing one or more of the five (5) services described within this RFS.  The expectation is that any provider requesting to be approved to provide services must have services available by (insert anticipated date that children will begin receiving HCBS Waiver services).

HCBS Waiver Program

The HCBS Waiver provisions under the Social Security Act Section 1915(c) enable states to offer a range of community-based, non-institutional care. These provisions allow the federal Center for Medicare and Medicaid Services (CMS) to "waive" specific statutory requirements so that certain essential community-based services can be financed by Medicaid even though they are not included in a state's Medicaid plan.  Without this waiver, the children would require institutionalization to receive a comparable level of services.

Through waiving certain requirements of the Social Security Act, New York State has enabled three things to occur:

  1. The program can be offered only in specific counties in New York State.
  2. For children enrolled in the HCBS Waiver, six new services (Individualized Care Coordination, Respite Care, Skill Building, Intensive In-Home Services, Crisis Response, and Family Support) will be available in addition to existing State Medicaid Plan services.
  3. The HCBS Waiver will not consider parents' income and resources when determining a child's Medicaid eligibility.

The HCBS Waiver program provides families in New York State with more community-based alternatives to enable children to remain at home and in the community without additional costs. To the extent possible, it enables families to choose providers in their catchment area.  The HCBS Waiver is now present in all counties except Oneida.

The goals of the HCBS Waiver are:

Individualized Care Approach

The Individualized Care model requires that providers work in collaboration with the child, family and other child-serving systems to develop an individualized service plan for each child and their family. Individualized Care emphasizes the following major values:

Target Population

The target population for the HCBS Waiver includes children and adolescents:

Additionally, the children 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 a HCBS Waiver program.

Children receiving care in Residential Treatment Facility (RTF), Intensive Case Management, Supportive Case Management, Community Residence, Family Based Treatment, other HCBS Waiver programs or comparable programs in other service systems  (e.g., DSS Therapeutic Foster Care) cannot be enrolled in this HCBS Waiver unless they will be discharged and returned home by the enrollment date.  Children who reside in foster family homes may be eligible for the HCBS Waiver.

Enrollment Process

Children and adolescents are eligible for the HCBS Waiver program if they meet the above mentioned criteria. Referrals come from SPOA’s.  An approval process is undertaken for each referral, in conjunction with the (insert name of LGU) to determine eligibility and level of care.

Once a child or adolescent is enrolled in the HCBS Waiver, an individualized service plan is developed. The Individualized Care Coordinator (ICC) coordinates a service planning team with the child and family.  Identified Waiver and other services are coordinated by the ICC.  Waiver service providers referenced in the service plan become members of the child's service planning team and must participate fully in the process.

Once an initial plan of care is developed for each child and family, a corresponding budget is developed for the package of services.  A determination must be made that there is reasonable expectation that the annual total of all medical assistance expenditures will not exceed the federal annual cap per slot.  Although some children will have higher or lower expenditures, over the whole program statewide, the average expenditure must not exceed the New York State Office of Mental Health’s annual CAP per slot.

Freedom of Choice/Fair Hearing

Upon determination of eligibility for HCBS Waiver services, the child and family are informed of any feasible alternatives and are given the choice of either institutional or home and community-based services. However, determinations of eligibility cannot exceed the total number of slots available. A fair hearing will be provided upon request for any family whose choice of home and community-based services as an alternative to institutional care is denied for reason other than the number of slots in the area being already filled, or who are denied the service(s) of their choice or the provider(s) of their choice.  [The family will also be informed that the option of requesting an Agency Conference (pursuant to 18 NYCRR 358-2.4) is available prior to requesting a formal hearing.]

The Individual Care Coordination (ICC) Agency

The designated Individualized Care Coordination Agency:

In (insert name of county) County, the approved ICC Agency is (insert name of ICC Agency).

Approval of Five Services Providers

The Local Governmental Unit designates agencies that may provide HCBS Waiver services in each geographic area in conjunction with the Local Social Services District and with the approval of the Office of Mental Health. (See Service Definitions and Requirements section for elaboration on qualifications for each individual service.) It should be noted that there may be more than one approved provider for each service. All providers are required to execute a written contract with the ICC Agency, outlining the requirements and expectations of the collaboration.

 Expectations

The approved providers of the other five HCBS Waiver services will be expected to meet the following general requirements. Specific functions will be addressed in the written contract with the ICC Agency.

Service Definitions and Requirements

A service provider in a given county may elect to express interest in providing one or more of the following five services in the HCBS Waiver. Prior to delivery of services, each individual worker must provide professional and/or personal references, a personal history of their experience and appropriateness to provide the service, clearance by the State Child Abuse Registry, clearance through OMH’s Bureau of Criminal History Information (fingerprinting), and demonstrate that he/she meets the qualifications for the service to be provided and has completed training requirements. Services must be available by (insert date). A description of the service and the worker standards follows.

Skill Building Service Workers

Skill Builder Job Description:  Skill Builders focus on the developmental stage of the child and work with the child towards achieving age appropriate developmental tasks. They design and provide activities that assist children in developing skills needed to live successfully in their homes and communities. Skill Builders help the child to identify current assets and strategies for acquiring desired ones.  Activities may support areas such as completing schoolwork, being part of a team, socialization, handling money and activities of daily living.  Skill Builders may also work with youth in developing skills for independent living and in accessing vocational skills training.  Skill Builders can provide services to an individual child or in a group with other Waiver children.  They may also work with the Waiver child’s family, including siblings, in teaching them how to best support the child in maintaining the skill sets. 

Qualifications:

Skill Building Service workers must:

Training:

Skill Building Services workers must:

Respite Care Services Workers

Job Description:  Respite Workers temporarily care for the Waiver child, on an emergency or planned basis, providing relief from care-giving responsibilities for the family. This eases the on-going stress often experienced by families of children with serious emotional disturbances. Respite Workers supervise the child and engage the child in recreational activities that support his/her constructive interests and abilities. Respite may occur night or day in the child’s home, the respite worker’s home or in the community with one child or a group.

Qualifications:
Respite workers must:

Training:

Family Support Service Workers

Family Support Worker (FSW) Job Description:

FSW’s are parents who are raising or have raised a child with mental health concerns and are personally familiar with the associated challenges. FSW’s offer the integrity of their experience to the families they serve and are often able to connect with waiver families based on a unique understanding of their circumstances. FSW’s have first hand knowledge of the services and supports available in the community.  FSW’s offer waiver families’ activities designed to enhance the family unit, ultimately developing safe, stable, and supportive families who are connected to their communities.

 FSW’s offer resources, including, but not limited to:  education, advocacy and support.  FSW’s offer information to families on community resources, assist families in connecting to community resources and natural supports, and advocate with the family to access supports, services and activities.  FSW’s introduce and connect families to community activities which foster family cohesion.  These activities, which may be cultural, educational or recreational, are individualized for each family based on their culture, needs, values and preferences and are consistent with the family’s income to assure the possibility of continuing the activities post-Waiver. FSW’s are also expected to facilitate family/parent support groups.  Family support group activities for parents (i.e., monthly meetings, game nights, annual picnics) are provided as a venue for engaging parents with similar experience as a way of assisting in building natural support systems in their communities. 

FSW’s may work with an individual parent/guardian or a group of Waiver parents/guardians.  Workers must be supervised by an individual who meets the criteria for a "qualified mental health staff person".

Qualifications:

Family Support Services workers must:

Training:

Family Support Services workers must:

Crisis Response Services Workers

Job Description:  Crisis Response Services Workers perform interventions designed to assist children and families when they are in crisis. These workers provide immediate, short-term interventions until linkages are made with other appropriate services. This may include assessment, consultation, facilitating the safety plan’s interventions and referral wherever and whenever necessary on a 24 hour/7 day a week basis.  

Qualifications:

Crisis Response workers must:

Training:

Crisis Response workers must:

Intensive In-Home Services Workers

Job Description: The Intensive In-Home (IIH) worker supports the child and family in implementing both their Treatment Plan (from the clinical provider) and the Waiver Service Plan (established by the Waiver program).  The IIH worker receives direction from the Individual Care Coordinator who assures the initial and on-going flow of clinical information between the ICC, the treatment provider and the IIH worker. The IIH worker engages the child and family in ways that support the everyday application of treatment methods as described in the child’s Treatment Plan and Waiver Service Plan.   Specifically, the IIH worker reinforces desired cognitive and behavioral changes to prevent crises and to support the emotional well-being of the family.   As each family is unique,  strategies are designed to be sensitive to the culture and values of each individual family and may include: psycho-education, post crisis de-briefing, re-enforcing the integration of safety plans in the home, parent-child relationship building, teaching parenting skills, providing support in emotional self-regulation in situational contexts, encouraging supportive sibling relationships with the Waiver child, developing healthy coping mechanisms, making healthy choices, building self-esteem, clarifying identity issues, etc.  IIH Services may be provided in the home or in the community for an individual child and their family. 

Qualifications:

Intensive In-Home workers must:

Training:

IIH workers must complete:

Training is strongly recommended in areas such as working with specific child diagnostic populations, overviews of evidence based practices, child and adolescent developmental stages, substance abuse, trauma, suicide prevention, teaching parenting skills, and stress management techniques.

Responding to the Request for Services - Instructions

Eligible Applicants:

Any agency that feels it can provide the county's HCBS Waiver program with a pool of workers who meet the individual service provider and worker qualifications may apply. The applicants must be able to satisfactorily demonstrate the points outlined in the narrative format below. For HCBS Waiver sites serving multiple counties, an agency must submit a separate application to each county that it would like to serve.

Format:

Each application must contain the following and not exceed 10 pages in length:

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