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Office of Mental Health

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

400.7

Inpatient Stays for Waiver Enrollees

Policy

By nature of their clinical eligibility for the HCBS Waiver, it is expected that some Waiver enrollees will need short-term psychiatric hospitalization to stabilize a crisis. A child may also require medical hospitalization while enrolled in the Waiver. The child’s slot may remain active during any inpatient hospitalization for up to 60 days out of a 75-day period. A longer hospital stay, or if it has been determined at an earlier time that the child will need long term hospitalization, necessitates disenrollment of the child from the HCBS Waiver.

Monitoring of Inpatient Stays

The ICC Agency will monitor the utilization of inpatient level of care for children enrolled in the HCBS Waiver. The ICC will be in at least weekly contact with the inpatient facility to monitor the child’s progress and discharge date. To facilitate obtaining information from the hospital related to expected length of stay, two sample letters, to be transferred to ICC Agency letterhead, and a consent to release information form may be sent. These letters request that the hospital release the physician’s determination on length of stay and may be used at two points in time: 1) date of child's admission to the facility and 2) 35 days later, should the child still be hospitalized.

Should an inpatient care facility determine that a child will remain in care for 60 days or more in a 75-day period, the child/family must be informed and disenrollment from the HCBS Waiver must begin. If disenrollment is indicated, the ICC will forward the hospital’s documentation, with a signed Loss of Waiver Eligibility from the LGU, to the OMH Operations Support Unit to begin the disenrollment process.

Services During Inpatient Stays

Please refer to billing rules surrounding an inpatient stay in Chapter 600.

Reporting of Inpatient Stays

The Office of Mental Health monitors inpatient service utilization from the financial management reports. However, not all inpatient utilization will be captured through the MMIS claiming process.  Some children receiving inpatient services from State Psychiatric Centers may have claims billed to a second Medicaid ID number which OMH may not have.  In these cases, expenditures will not appear on the fiscal reports.  Also, children with claims paid by other third party health insurers may not show utilization through the fiscal reports.

In order to capture this information and to offer assistance earlier in the hospitalization period, if needed, OMH requests on-going reporting of data via CAIRS of individual child’s admission and discharge dates as well as whether they received services in a State Psychiatric. Information should also be provided regarding whether any psychiatric inpatient services were paid for through Third Party Insurance (TPHI).

Allowable Services During Inpatient Stays

Please refer to billing rules surrounding an inpatient stay in Chapter 600. ICC services may be delivered to the child and the child's family in accordance with the child's service plan goals while a child is hospitalized.  When Intensive In Home is a bundled service, it may also be provided per the child's service plan.  In order to bill, the usual number of ICC face to face contacts must be made within the month and the child must return to the Waiver from the hospital. No hourly services or daily respite, other than bundled IIH, can be billed for while a child is hospitalized.

Sample Letter To Hospital - At Admission

Date

RE: (Child’s name, date of birth, admission date if known)

Medical Record Department
ATTN: Director
(Address)

This is a request to obtain information about the above-named child who is in your hospital.  This person is enrolled in our Home and Community-Based Services Waiver program which is under the direction of the NYS Office of Mental Health.

Please have the attending physician provide the following information and return it to my attention within 10 days. A copy of Form OMH 11 (Consent for Release of Information) is attached in order to expedite the process.

Please indicate:

  1. The projected discharge date for this child is ___ /___ /___ Or
    The anticipated length of stay for this child in this inpatient setting is:
    • 45 to 60 days
    • 61 to 75 days
    • 75 to 90 days
    • More than 3 months
  2. The current discharge criteria is:
  3. The current treatment goals/objectives and their corresponding target dates are:

Signature and title of Person completing this form

Date of Completion

Copies of documents addressing this information are acceptable in lieu of the above information.  They may include such documents as:

If the child’s length of stay is anticipated to be less than 60 days, we would appreciate being involved in the treatment planning and discharge planning process. Thank you in advance. If you have any questions, I can be reached at:


Sample Letter To Hospital - At 35 Days

Date

RE: (Child’s name, date of birth, admission date if known)

Medical Record Department (or Medical Director if known from last time)
ATTN: Director
(Address)

This is a request to obtain additional information about the above-named child who is in your hospital.  As stated in our previous letter, this person is enrolled in our Home and Community-Based Services Waiver program which is under the direction of the NYS Office of Mental Health.

Please have the attending physician provide the following information and return it to my attention within 10 days. A copy of Form OMH 11 (Consent for Release of Information) is attached in order to expedite the process.

In the previous documentation, your facility estimated the length of stay to be: Please indicate:

  1. The patient’s length of stay is still ___________
    The projected discharge date for this child is___ /___ /___ Or
    The anticipated length of stay for this child in this inpatient setting is:
    • 45 to 60 days
    • 61 to 75 days
    • 75 to 90 days
    • More than 3 months
  2. The current discharge criteria is:
  3. The current treatment goals/objectives and their corresponding target dates are:

Signature and title of Person completing this form

Date of Completion

Copies of documents addressing this information are acceptable in lieu of the above information.  They may include such documents as:

If the child’s length of stay is anticipated to be less than 60 days, we would appreciate being involved in the treatment planning and discharge planning process.
Thank you in advance. If you have any questions, I can be reached at:


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