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Office of Mental Health

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

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500.8
Termination from the HCBS Waiver

Considerations

Reasons and Responsibility for Termination

It is mainly the responsibility of the ICC for initiating terminations.

Following are the most common and frequent reasons that a child's enrollment in the HCBS Waiver would be terminated:

Note: Although there may be other reasons for termination, it is anticipated that these would be rare situations and should be handled on a case by case basis.

Discharge Plan Follow-Up

Each ICC Agency is expected to develop a discharge follow-up policy to verify discharge plan implementation. The policy may allow for different follow-up procedures and schedules for individual children/families depending on their needs. See Chapter 400.

Impact Termination from HCBS Waiver Has on Child's Medicaid Eligibility/Coverage

As part of the termination process, the ICC assists the family in understanding the ramifications that termination from the HCBS Waiver will have on the child's continued Medicaid coverage post-enrollment and determine whether the family is interested in continuing the child's Medicaid coverage, if possible. Note: If the child had Medicaid prior to enrollment in Waiver then the Medicaid should continue. Waiver enrollment/disenrollment will not have any effect on the Medicaid.

The family should be advised to contact the LDSS directly regarding changing the Medicaid coverage from HCBS Waiver to non-Waiver status. In cases where the child's Medicaid coverage will be terminated after leaving the HCBS Waiver, the ICC must advise the family that they should stop using the child's Medicaid card to purchase services as of the date that the child is determined by the ICC/ LGU to no longer be eligible for the HCBS Waiver. (Charges incurred between the date the child becomes ineligible and the date the LDSS closes the case on the WMS system will charge back to the HCBS Waiver.) A separate notice advising the parent/guardian of the actual closure of the Medicaid case will be sent from the LDSS once the case is actually closed on the system.

Note: In this context, LDSS means the local Social Services Medicaid Unit for all non-NYC counties and the applicable Medicaid units in the Human Resources Administration (HRA) for all NYC boroughs.

Procedures for Terminations

ICC Actions:

Document Reason for Termination: ICC documents the reason for termination and initiates completion of the Notice to LDSS Regarding: Loss of Waiver Eligibility Form (PDF).

Form Supply: An ICC can either photocopy the form or use the one on the OMH website. If supplies are photocopied, it is recommended that the agency type its address and phone number taking care to ensure that it does not exceed one page. A copy of this form has been provided to all LDSS Medicaid units as a standardized form.

Completion of Notice to LDSS Re: Loss of Waiver Eligibility Form: Complete the Notice to LDSS form as follows:

Check the box indicating the reason why the child is no longer eligible for the HCBS Waiver and enter the date that the child became ineligible. Note: Only box #3 allows more than one selection.

Signatures: The ICC signs and dates the form. If the reason for termination does not involve the LGU , (Level of Care Box #3) the LGU does not need to sign the form. However, if a Level of Care reason #3 is checked, then the LGU signature is required.

The ICC, whenever possible, meets with the family to obtain the parent/guardian's signature and ensures that the date on the form corresponds with the date of the signature. If a face-to-face meeting is not possible, these issues must be discussed over the phone and the parental signature line on the form should be annotated as follows: "Unable to meet, discussed with parent over telephone." The date of the phone conversation is entered in the date field. If the parent/guardian is not cooperating in the termination process, annotate the parent's signature line as follows: "Parent/guardian refuses to sign" and date the form.

Address Change: If the address has changed since the child's enrollment date, complete the box at the bottom of the page where the new address is requested. This updated information is needed by OSU to ensure that the NOD-Termination is sent to the correct address.

Distribution of Notice to LDSS re: Loss of Waiver Eligibility form (PDF): ICC distributes the completed "Notice to LDSS re: Loss of Waiver Eligibility form" (PDF) as follows:

Upstate/LI Programs - Original to the LDSS Waiver contact; Photocopy to NYC if termination caused by change in level of care.

NYC Programs - Photocopy to NYC if termination caused by change in level of care.

Terminating Services and Billing: The ICC discontinues providing services and billing for HCBS Waiver services effective the date of ineligibility that has been indicated on the "Notice to LDSS re: Loss of Waiver Eligibility form" (PDF).

LDSS/HRA Actions:

LDSS/HRA either reevaluates the child's Medicaid eligibility based on the child's current living arrangement using Medicaid standards/methodology applicable to the post–Waiver living arrangements or closes the Medicaid case. Action taken is dependent on whether the family wishes to continue Medicaid coverage and/or whether there is sufficient documentation for reevaluation.

If the child's Medicaid case is closed, the effective date of Medicaid closure is ten (10) days after the Notice Date (determined by the date the LDSS inputs the closing transaction in the WMS system).

LDSS/HRA notifies the family of the action that has been taken regarding the child's Medicaid and the effective date of this change.

Note: This section pertains to those cases where the child had to apply for Medicaid as part of the waiver enrollment process. If the child had Medicaid prior to waiver the Medicaid should continue, waiver enrollment/disenrollment does not have any effect on the Medicaid in those cases.

OSU Actions:

Upon receipt of the Transmittal 3 in CAIRS, which contains Loss of Waiver effective date and corresponding reason, OSU terminates the RE Code 23 with the appropriate effective date of termination.

OSU electronically replies to Transmittal 3, and employs reporting features in CAIRS to produce hard copies of “Waiver Notice of Decision – Termination”. Original copies of the termination letters are sent to Child/Family, LGU, LDSS (Upstate only); and NYC, where applicable. CAIRS reports allow the HCBS Waiver providers to print a copy of the Waiver Notice of Decision – Termination immediately following OSU’s electronic response to the Transmittal 3 transaction.

Note: This form contains a statement of the child/family's rights to appeal the termination decision and request a Fair Hearing. See section 500.9 for Fair Hearing Procedures

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