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Office of Mental Health

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

200.1

Selecting an Individualized Care Coordination Agency Policy

Criteria for Selection of The ICC Agency

In each HCBS Waiver county, an agency, or agencies, must be designated to serve as the coordinating, lead entity.  This agency is referred to as the "Individualized Care Coordinating" (ICC) Agency.  A county may have more than one ICC Agency.  Each ICC Agency may serve more than one county.  In order to select a new ICC Agency or allocate additional slots to an existing ICC Agencies, providers must be evaluated using the below criteria:

Criteria

In order to meet the requirements for becoming an ICC Agency or expanding an existing ICC Agency’s Waiver program with additional slots, the agency must demonstrate:

Existing ICC Agency providers must also:

Approval Process for ICC Agencies

The process of selecting an ICC Agency outlined below must be followed when a county has been allocated 12 or more slots. The process requires the Local Governmental Units (LGUs), i.e., county Departments of Mental Health, to:

Recommending a New ICC Agency or the Expansion of Slots for an Existing ICC Agency

Submit a written recommendation to the Office of Mental Health’s Division of Integrated Community Services for Children and Families, outlining which existing ICC Agency should receive additional slots or which provider should be chosen as a new ICC Agency with a description of how the provider best meets the criteria.  For new ICC agencies, also include the "HCBS Waiver Qualifications: ICC Provider" application.

OMH will then perform a check on the provider to verify that the agency is administratively competent and has no outstanding practice or financial issues which would impede its ability to be the ICC Agency or receive an expansion in slots.  OMH forwards a letter to the county Department of Mental Health stating its approval/disapproval of the choice.  If disapproved, the county Department of Mental Health may make another recommendation and follow the same procedures.  Once the ICC Agency has been approved, the county Department of Mental Health informs the provider in writing that they have been selected and notifies other providers of the county’s choice.

In order to bill Medicaid for waiver services provided through the HCBS Waiver, a new ICC Agency must be enrolled as a Medicaid provider of HCBS Waiver services (category of service 0268).  As soon as the selection of the ICC Agency has been approved by OMH, OMH requests that the NYS Department of Health initiate the provider enrollment process by sending an enrollment application package to the ICC Agency.   The ICC Agency completes the application package and returns it to the Department of Health as soon as possible.  The ICC Agency is notified when the enrollment application has been processed.   If the ICC Agency has an existing OMH Community Residence, Family-Based Treatment program, PROS or ACT program, that Medicaid provider number will also be used for the HCBS Waiver program.  Otherwise, a new Medicaid provider number will be assigned.

Contracts

OMH Contracts

Individualized Care Coordination (ICC) agencies are required to enter into a direct contract each year with the Office of Mental Health before Waiver services can be provided and billed to Medicaid.  Information regarding the contract, related OMH fiscal reports, and the fiscal policies that govern the Waiver program are available at the OMH’s website:   http://www.omh.ny.gov  Select Information for Service Providers and go to Spending Plan Guidelines.  In addition, the OMH Field Offices are available to provide technical assistance to ICC agencies pertaining to contracts and fiscal reports.

Each agency must submit a Consolidated Budget Report (CBR) and a Consolidated Claim Report (CCR) using the Internet-based Consolidated Fiscal Reporting System (see above link).   Each ICC agency must submit its contract annually to its respective Field Office for review. Upon review of the contract and approval of the budget, the Field Office forwards the contract to OMH’s Central Office for final approval and signature.  Changes that occur during the year affecting slot allocations, budget amounts, or other significant areas require a contract amendment.

The OMH has many direct contracts with providers for services that are either partially or fully reimbursed by Medicaid.  Unfortunately, not all of these contracts are submitted by providers in a timely manner.  In those instances, OMH is left without any contractual agreement with the providers governing the delivery of services or the rights and responsibilities of each party.  Therefore, OMH and the NYS Department of Health (DOH) have agreed on and implemented a process whereby OMH instructs DOH to interrupt temporarily the payment of Medicaid associated with overdue contracts.

LGU/LDSS Contracts for Children in Foster Homes

Children who live in foster boarding homes are eligible for Waiver services; however, children in therapeutic foster homes are not. Prior to enrollment of a child in foster care into the HCBS Waiver, the ICC Agency executes a contract with the LGU and LDSS of each county it serves. There are two different contracts, one for county operated homes and one for voluntary agency operated homes.

Foster care contracts outline the roles and responsibilities of each party, including that of any voluntary agencies serving the child.

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200/1A - Sample Template For Advertisement In County For ICC Agency

The _____________ County Department of Mental Health, in conjunction with the ___________ County Department of Social Services, is pleased to announce a new program that will be implemented ___________ (date).   We are looking for a provider that would be interested in the coordination and provision of services to children and adolescents with serious emotional disturbance and their families.

The Home and Community-Based Services (HCBS) Waiver provisions under the Social Security Act Section 1915(c)  allow  the federal Center for Medicaid Services (CMS) to waive certain statutory requirements so that specific essential community-based services can be financed by Medicaid, even though they are not currently in the State’s Medicaid Plan.

The target population for the HCBS Waiver is children and adolescents with serious emotional disturbance between the ages of 5 and 17 years, who demonstrate complex health/mental health needs and who, without the provision of the Waiver’s specialized services, would require long-term institutionalization.  They must require services from more than one system, have a viable home environment with parents/guardians who are willing to participate and to support the children at home.  They must, also, reasonably be expected to be served under the HCBS Waiver at a cost which does not exceed that of psychiatric institutional care.

Goals of New York’s HCBS Waiver are:

Through the service plan process, the target population will be able to obtain needed services and supports beyond those currently reimbursable through Medicaid.  The services that NYS is requesting to make available to children and adolescents enrolled in the HCBS Waiver are: Individualized Care Coordination, Intensive In-Home Services, Respite Care, Family Support Services, Crisis Response Services and Skill Building Services.

If your organization/agency is interested in becoming the Individualized Care Coordination Agency for the HCBS Waiver, please send a letter to ________________ by ______________. 

We expect respondent agencies to justify how they meet the following requirements: previous record of administrative competence; history of good interagency relationships locally (with schools, DSS, DMH, Probation, Family Court, etc.); current Medicaid certification; an expressed willingness to be creative and flexible; expressed willingness to establish "parent-professional" partnerships; consumer participation in program design and internal evaluation process; and experience delivering  community-based services in a strength-based manner to children and families including positive feedback from participating consumers and their families.

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