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Office of Mental Health

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

200.2

Developing a Provider Network: Criteria, Approval Process, Contracts

Policy

Each ICC agency seeks to provide to the children and families it serves with the widest possible choice of service providers. Providers contract with the ICC agency following a selection/approval process which begins with the completion of a Request for Services for Subcontract Agencies. From these, the Local Government Unit makes a formal recommendation which is forwarded to the OMH for further review and approval.

Requirements for Five Waiver Services Providers

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

Process for Developing a Network of Subcontractors

For each county, the LGU will be asked to issue a Request For Services (RFS) for subcontract agencies advertising the opportunity for providers to join the HCBS Waiver network.  This is distributed, with the Provider Network Invitation Letter (see the following template 200/2A), to providers in the county, who have a wide area of appropriate expertise and probable interest in providing respite services, intensive in-home services, crisis response services, family support services and/or skill building services. The LGU reviews the completed RFS’s and sends the "HCBS Waiver Qualifications: SubcontractorPDF Document" application to eligible providers.

Approval of a Network Provider

The LGU reviews providers’ responses and qualifications in conjunction with the local social services district and makes a recommendation in writing to OMH identifying which providers are appropriate to provide one or more of the  five HCBS Waiver services using the Subcontractor Recommendation(200/2B). "The HCBS Waiver Qualifications: Subcontractor" completed application must be attached to this. OMH reviews the recommendations by checking the agency’s credentials. This final check ensures that the potential provider agency has no outstanding issues with OMH (performance or financial) that would impede its participation in the HCBS Waiver. OMH then issues a letter to the LGU approving, disapproving or requesting additional information. Once approved, the provider works closely with the ICC Agency to establish a contract, hire any necessary staff and complete training requirements.

Please note: ICC Agencies can go through this process and be approved to provide any or all of the remaining five HCBS Waiver services, keeping in mind the need to provide choices in providers whenever feasible.

The HCBS Waiver Subcontractor Recommendation is not required for individuals applying as independent subcontractors. The ICC agency can approve their own individual independent subcontractors after ensuring that the individual meets all training, experience, and other requirements for that service and that the philosophical values of the Individualized Care Model are followed. The ICC agency should provide on-going supervision to individual independent subcontractors for training, service provision, documentation, billing and appropriate boundaries with child and family. The ICC agency must ensure that appropriate liability insurance (either through an ICC agency’s umbrella policy or through independent liability insurance) is in place as well as automobile liability insurance, depending upon the role of the independent subcontractor. During the annual site visits, individual independent subcontractor qualifications are reviewed.

Approval of providers is an ongoing process as localities and families identify providers that are of interest as HCBS Waiver network  providers.  After the initial RFS to establish new network providers is sent and processed within a county, providers may request approval at any point in time.  The same process of LGU review, recommendation and OMH approval is followed.

Withdrawal of Approval

A HCBS Waiver provider may lose approval to work with the network if the agency fails to continue meeting the qualifications, if there are serious concerns with performance and ability to maintain requirements of the program, or if the provider does not cooperate with the ICC Agency as the primary coordinator of care for enrollees. Should any of these issues arise in a county, the LGU may recommend withdrawal of approval to OMH.  Only the Office of Mental Health has the authority to approve or disapprove a provider.

200/2A
Template of Provider Network Invitation Letter

Dear County Service Providers:

Date

The (insert LGU’s name) is pleased to announce the availability of a Home and Community-Based Services (HCBS) Waiver for children and adolescents with serious emotional disturbance and their families. We are seeking providers who are interested in providing one or more of the component HCBS Waiver services under this program.  Enclosed is the Request for Services (RFS) which lists the criteria for provision of these services and the requirement for obtaining approval as a network provider.

The HCBS Waiver allows for the provision of community-based service(s) for a child who meets the level of care need for a Residential Treatment Facility (RTF) or an intermediate inpatient stay. The HCBS Waiver is guided by the principles of Individualized Care, which focus upon the strengths of the child and family, meeting the child's individualized needs with flexibility and creativity, establishing a partnership with the family, and collaborating with other service systems.

A provider may indicate interest in providing any or all of the following five services: respite care (hourly, daily), intensive in-home services, crisis response services, family support services, and skill building services. Agencies currently providing services in the county are eligible to apply.  All potential applicants must submit their proposals by (insert due date) to (insert name of person to whom the response should be addressed). Should you have any questions, please contact (insert name of contact person) at (list phone number).

Sincerely,

Enclosure

200/2B
HCBS Waiver Recommendation of Subcontractor

On behalf of ___________________________ (county name), I recommend the following providers* be approved as subcontractors for designated Waiver services. I have reviewed the responses to the Request for Services (RFS) and consider the agencies listed below to be qualified and able to provide services to HCBS Waiver enrollees and their families in keeping with the Individualized Care Model.

Respite:

Family Support:

Skill Building:

Intensive In-home:

Crisis Response:

LGU Representative Name (Print):

LGU Representative Signature:

Date:

* ICC Agencies must also be approved for any of the five other waiver services they may wish to provide.

Please return to HCBS Waiver Program Coordinator, Division of Children and Families, Office of Mental Health, 44 Holland Ave., Albany, 12229.

Contracts with Network Providers

In order to comply with CMS rules and regulations governing New York’s HCBS Waiver, the ICC Agency is required to execute a written contract document with each provider agency.  The ICC Agency serves as the Organized Health Care Delivery System (OHCDS) for all waiver services. Although the NYS Department of Health and the Office of Mental Health cannot develop a template, it is recommended that the components of the contract document mirror the elements of the OMH/ICC Agency contract and at a minimum include:1) philosophy, 2) discussion on reporting incidents, 3) Medicaid billing, 4) qualifications and other standards, 5) record keeping and 6) documentation requirements.

Timeline for Completion

Once a provider is approved to provide HCBS Waiver services, a contract must be in place  three (3) months from the date of OMH’s approval letter to the LGU. This is reviewed during the annual site visits.

Documentation with ICC Agency

Each contract document will detail record keeping and documentation requirements, including the requirement that all original Progress Notes are submitted to the ICC Agency. All original records relating to provision of HCBS Waiver services are retained at the ICC Agency.

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