Friday, March 22, 2019
Service Specific Webinar 4: Family Peer Support Services, Youth Peer Support and Training, & Crisis Intervention as Interim HCBS
Children’s System: Home and Community Based Services (HCBS) under the Children’s Wavier
2March 22, 2019
Introduction and Housekeeping
• Slides and recording will be posted at MCTAC.org
• Reminders:
• Information and timelines are current as of the date of the
presentation
• This presentation is not an official document. For full details please refer
to the provider and billing manuals.
3March 22, 2019
Agenda
• HCBS Overview of Key Concepts
• Family Peer Support Services
• Youth Peer Support and Training
• Crisis Intervention
• HCBS Eligibility and Crosswalk of Services
4March 22, 2019
HCBS Overview of Key Concepts
5March 22, 2019
Timeline Update
6March 22, 2019
Overview of Children’s Aligned HCBS TimelineApril 1, 2019:
• 1915(c) Children’s Waiver is effective and former 1915(c)Waiver will no longer be active (pending CMS approval)
• All children enrolled in the former children’s 1915(c) waiver program must be transitioned to the 1915(c) Children’s
Waiver
Former children’s 1915(c) Waivers:
• Office of Children and Family Services (OCFS) Bridges to Health (B2H) Serious Emotional Disturbance (SED),
• OCFS, B2H Developmental Disabilities (DD),
• OCFS, B2H Medically Fragile (MedF),
• Office of Mental Health (OMH) SED Waiver,
• Office for People With Developmental Disabilities (OPWDD) Care at Home (CAH) IV Waiver,
• Department of Health (DOH) operated Care at Home (CAH) I/II Waiver
* Children’s HCBS waiver will be billed Fee for Service (FFS) for all children enrolled in the Children’s Waiver
July 1, 2019: Three year phase in of Level of Care (LOC) expansion begins
October 1, 2019: 1915 (c) Children’s Waiver Services carved into Managed Care
• If child in Medicaid Managed Care Plan (MMCP) – bill Managed Care Plan.
• If child not in MMCP – bill Fee-For-Service.
7March 22, 2019
Key Concepts
• Home and Community Based Services (HCBS) and new Children and Family
Treatment and Support Services (CFTSS) are different and have different
requirements, processes and paths to care.
• Providers must be designated to provide these services.
• Built in flexibility to allow for creativity.
• Waiver Capacity/Slots: As of April 1st, all current slots will be combined and will
remain the same until July 1st, 2019 when capacity expansion will begin.
More information on capacity/slot management forthcoming
8March 22, 2019
Key Concepts
• The transition of children from the six current Waivers into the
consolidated Children Waiver requires that we assure Continuity
of Care for those children/youth receiving the six waiver services
today.
• Children in some of the current Waivers today receive Family
Peer Support, Youth Peer Support and Crisis Intervention
Services.
9March 22, 2019
Key Concepts • All services will be provided in accordance with service descriptions, staff
qualifications, training requirements, etc. outlined in the HCBS Manual
• While services are authorized HCBS and provided ONLY to HCBS enrolled
children,
• A LPHA recommendation is NOT required, the Level of Care determination will
establish the child’s eligibility for the service
• Only the Health Home Care Manager (HHCM) or the Independent Entity, C-YES
(Children and Youth Evaluation Services) Care Coordinator can refer children to
the HCBS Service Provider
• HCBS Providers must develop and maintain a HCBS Service Plan for the services
they provide, for documentation and billing purposes
10March 22, 2019
Key Concepts • FPSS, YPST, and CI will be authorized as HCBS until they are
authorized as CFTSS.
• Family Peer Support Services will be implemented as CFTSS on July
1, 2019
• Youth Peer Support and Training & Crisis Intervention Services will be
implemented as CFTSS on January 1, 2020
• When they transition to CFTSS, they will be available to all children
with Medicaid who meet medical necessity criteria
11March 22, 2019
Core Principles
12March 22, 2019
HCBS Settings
Allowable settings in compliance with Medicaid regulations and the Home and
Community Based Settings Final Rule (§441.301(c)(4) and §441.710) will exhibit
characteristics and qualities most often articulated by the individual child/youth and
family/caregiver as key determinants of independence and community integration.
Services should be offered in the setting least restrictive for desired outcomes,
including the most integrated home or other community-based settings where the
beneficiary lives, works, engages in services and/or socializes. While remaining
inclusive of those in the family and caregiver network.
Family is broadly defined, and can include families created through: birth, foster care,
adoption, or a self-created unit.
13March 22, 2019
Billing Interim HCBS
FPSS
• Starting 4/1/19, bill fee-for service.
• July 1, 2019, move to MMC upon transition to CFTSS authorization
YPST and CI
• Starting 4/1/19, bill fee-for service.
• October 1, 2019, move to MMC under HCBS;
• January 1, 2020 remain in MMC upon transition to CFTSS authorization
14March 22, 2019
Billing Fundamentals Fundamentals
If child is in a Medicaid Managed Care Plan (MMCP) – bill Managed Care Plan
MMCPs will be required to pay government rates [aka Medicaid fee-for-service rates] for
at least 24 months from the date the service was included in the Medicaid Managed
Care benefit package, or however long NYS mandates
In order to bill MMCP you need to be in-network
• In order to be in network you have to be credentialed and contracted
• Managed Care Plan Matrix
• All designated agencies must be enrolled as Medicaid providers agencies
If child is not in MMCP – bill fee-for-Service
Single Case Agreements (SCA) may be executed by Medicaid Managed Care for
specific services for specific clients.
15March 22, 2019
Limitations and Exclusions for all 3: FPSS, YPST and CI• Rehabilitative services do not include and FFP (Federal Financial Participation) is not available for any of the following:
• educational, vocational, and job training services;
• room and board;
• habilitation services such as financial management, supportive housing, supportive employment services, and basic
skill acquisition services that are habilitative in nature;
• services to inmates in public institutions;
• services to individuals residing in institutions for mental diseases;
• recreational, or custodial (i.e., for the purpose of assisting in the activities of daily living such as bathing, dressing,
eating, and maintaining personal hygiene and safety; for maintaining the recipient’s or anyone else’s safety, and could
be provided by persons without professional skills or training);
• services that must be covered under other Medicaid authorities (e.g. services within a hospital outpatient setting).
• Services also do not include services, supplies or procedures performed in a nonconventional setting including: resorts, spas,
therapeutic programs, and camps.
• The provider agency will assess the child prior to developing a treatment plan for the child. Authorization of the treatment plan
is required by the DOH or its designee. Treatment services must be part of the treatment plan including goals and activities
necessary to correct or ameliorate conditions discovered during the initial assessment visits.
16March 22, 2019
Family Peer Support Services (FPSS)
17March 22, 2019
What are Family Peer Support Services?• FPSS are array of formal and informal activities and supports provided to
families caring for/raising a child who is experiencing social, emotional,
medical, developmental, substance use, and/or behavioral challenges.
• FPSS provides a structured, strength-based relationship between a
Family Peer Advocate (FPA) and the parent/caregiver for the benefit of
the child.
*The term ‘family” is defined as the primary caregiving unit and is inclusive of the wide diversity of primary
caregiving units. Family is a birth, foster, adoptive or self-created unit of people residing together, with
significant attachment to the individual, consisting of adult(s) and/or child(ren), with adult(s) performing duties
of parenthood/caregiving for the child(ren) even if the individual is living outside of the home.
18March 22, 2019
Family Peer Support Service Components
Engagement, Bridging and Transition Support
Self-Advocacy, Self-Efficacy and
Empowerment
Parent Skill Development
Community Connections and Natural Support
19March 22, 2019
FPSS Service ComponentsEngagement, Bridging and Transition Support
For example:
• Support a productive parent-provider partnership
• Assist families to express their strengths, needs and goals
• Accompany the family when visiting programs
• Address concrete or subjective barriers that may prevent full participation in
services
• Support families during transition (e.g. placements, in crisis, between
services, etc.)
20March 22, 2019
FPSS Service ComponentsSelf-Advocacy, Self-Efficacy, and Empowerment
For example:
• Empower families to partner in all planning and decision-making
• Model strengths-based interactions by accentuating the positive
• Prepare families for meetings and accompany them when needed
• Provide opportunities for families to connect to and support one another
• Empower families to make informed decisions
• Share information about resources, services
• Help the family consider and express their needs and preferences of the family
• Help families understand eligibility rules and the assessment process
• Help the family match services to their child’s strengths and needs
21March 22, 2019
FPSS Service ComponentsParent Skill Development
For example:
• Help learn and practice strategies to support their child’s positive behavior and
health
• Assist parents to implement strategies recommended by clinicians
• Provide emotional support to reduce isolation, feelings of stigma, blame and
hopelessness
• Provide individual and/or group parent skill development related to their child’s
needs
• Support the parent in their role as their child’s educational advocate by providing:
information, modeling, coaching
22March 22, 2019
FPSS Service ComponentsCommunity Connections and Natural Support
For example:
• Help the family to reconnect to natural supports already present in their lives
• Utilize families’ knowledge of their community to develop new supportive
relationships
• Help the family get involved in leisure activities in their community
• In partnership with community leaders, encourage interested families to become
more involved in faith or cultural organizations
• Conduct groups with families to create opportunities for ongoing natural support
• Work collaboratively with schools to promote family engagement
23March 22, 2019
Why Offer FPSS?
• Because of their lived experience, credentialed FPAs and CRPA-Fs are adept at
engaging parents and problem-solving any barriers to care.
• FPSS promotes family-driven practice by supporting parents to be informed and
active partners in the planning and delivery of services for their child and family.
• FPSS increases social support by connecting parents to others who can related.
• FPSS works directly with parents to enhance their capacity to parent a child with
challenges.
• FPSS promotes continuity across the different services a child is receiving (e.g.
school, mental health, primary care).
24March 22, 2019
FPSS Example
Bryan, a transitioning OMH SED waiver child, and his parents Mark and
Roger and grandmother Dot continue to have access to Family Peer
Support Services after April 1st.
Bryan and his family attend a small group lead by the Credentialed
Family Peer Advocate with a few other children and their families where
they can learn from each other’s experiences and offer support.
During the small group sessions the families discuss resources, and
contacts assist each other in connecting with others and become
involved in their communities.
25March 22, 2019
Modality
• Face-to face individual
• Face-to-face group
• Group composition of members should share common
characteristics, such as related experiences, developmental age,
chronological age, challenges or treatment goals. The service is
directed to the child/youth and includes contacts necessary for
treatment with the family/caregiver or other collateral supports.
• Group not to exceed 12 individuals total
26March 22, 2019
Staff Qualifications
• Family Peer Support can be delivered by individuals with lived
experience who have completed necessary requirements as a:
• Credentialed Family Peer Advocate: Contact Families Together of
NYS (www.FTNYS.org) or CTAC (www.ctacny.org) for detailed
training requirements.
OR
• Certified Recovery Peer Advocate with a Family Specialty: For
more information on the CRPA-F: www.asapnys.org/ny-
certification-board/
27March 22, 2019
Provider Qualifications
• Agencies must be designated through the NYS Children’s
Provider Designation Review Team. This requires agencies have
appropriate license, certification, and/or approval in accordance
with State designation requirements.
28March 22, 2019
Limitations and ExclusionsThe following activities are not reimbursable for Medicaid family support programs:
• 12-step programs run by peers;
• General outreach and education including participation in health fairs, and other activities designed to
increase the number of individuals served or the number of services received by individuals accessing
services; community education services, such as health presentations to community groups, PTAs, etc.;
• Contacts that are not medically necessary;
• Time spent doing, attending, or participating in recreational activities;
• Services provided to teach academic subjects or as a substitute for educational personnel such as, but
not limited to, a teacher, teacher's aide, or an academic tutor;
• Time spent attending school (e.g., during a day treatment program);
• Habilitative services for the beneficiary (child) to acquire self-help, socialization, and adaptive skills
necessary to reside successfully in community settings.
29March 22, 2019
Limitations and Exclusions ContinuedThe following activities are not reimbursable for Medicaid family support programs:
• Child Care services or services provided as a substitute for the parent or other individuals
responsible for providing care and supervision.
• Respite care.
• Transportation for the beneficiary or family. Services provided in the car are considered
transportation and time may not be billed under rehabilitation.
• Services not identified on the beneficiary’s authorized service plan.
• Services not in compliance with the service manual and not in compliance with State Medicaid
standards.
• Services provided to children, spouse, parents, or siblings of the eligible beneficiary under
treatment or others in the eligible beneficiary’s life to address problems not directly related to the
eligible beneficiary’s issues and not listed on the eligible beneficiary’s treatment plan.
30March 22, 2019
Youth Peer Support and Training (YPST)
31March 22, 2019
What is Youth Peer Support and Training?
• Formal and informal services and supports provided to youth,
who are experiencing social, medical, emotional, developmental,
substance use, and/or behavioral challenges in their home,
school, placement, and/or community centered services.
32March 22, 2019
YPST Service Components• Skill Building
• Developing skills for coping with and managing psychiatric symptoms, trauma, and substance use
disorders
• Developing skills for wellness, resiliency and recovery support
• Developing skills to independently navigate the service system
• Developing goal-setting skills
• Building community living skills
• Coaching: Enhancing resiliency/recovery oriented attitudes, i.e., hope, confidence, and self-efficacy
• Promoting wellness through modeling
• Providing mutual support, hope, reassurance and advocacy that include sharing one's own
"personal recovery/resiliency story" as the Youth Peer Advocating (YPA) deems appropriate as
beneficial to both the youth and themselves. YPA’s may also share their recovery with parents to
engage parents and help them “see” youth possibilities for future in a new light
33March 22, 2019
YPST Service Components ContinuedSelf-Advocacy, Self-Efficacy and Empowerment
• Developing, linking, and facilitating the use of formal and informal services, including connection to peer support
groups in the community
• Serving as an advocate, mentor, or facilitator for resolution of issues
• Assisting in navigating the service system including assisting with engagement and bridging during transitions in
care
• Helping youth develop self-advocacy skills (e.g., may attend a Committee on Preschool or Special Education
meeting with the youth and parent, coaching the youth to articulate his educational goals)
• Assisting youth with gaining and regaining the ability to make independent choices and assist youth in playing a
proactive role in their own treatment (assisting/mentoring them in discussing questions or concerns about
medications, diagnoses or treatment approaches with their treating clinician). The YPA guides the youth to
effectively communicate their individual perspective to providers and families
• Assisting youth in developing skills to advocate for needed services and benefits and seeking to effectively
resolve unmet needs
• Assisting youth in understanding their treatment plan and help to ensure the plan is person/family centered
34March 22, 2019
YPST Service Components Continued• Community Connections and Natural Supports
• Connecting youth to community resources and services. The YPA may
accompany youth to appointments and meetings for the purpose of mentoring
and support but not for the sole purpose of providing transportation for the
youth
• Helping youth develop a network for information and support from others who
have been through similar experiences, including locating similar interest
programs, peer-run programs, and support groups
• Facilitating or arranging youth peer resiliency/recovery support groups
• Engagement, Bridging and Transition Support
• Acting as a peer partner in transitioning to different levels of care and into
adulthood; helping youth understand what to expect and how and why they
should be active in developing their treatment plan and natural supports
35March 22, 2019
Why offer YPST?
• Provide the training and support necessary to ensure engagement and
active participation of the youth in the treatment planning process and
with the ongoing implementation and reinforcement of skills.
• Activities emphasize the opportunity for the youth to expand the skills
and strategies necessary to move forward in meeting their personal,
individualized life goals, develop self-advocacy skills, and to support
their transition into adulthood.
36March 22, 2019
YPST Example
Leo meets with a Youth Peer Advocate (CRPA-Y) to assist with
substance use challenges. The YPA provides mutual support, hope,
reassurance, and advocacy that includes sharing one's own "personal
recovery/resiliency story" as the Youth Peer Advocate (YPA) deems
appropriate as beneficial to both the youth and themselves.
Leo meets the YPA in the community to engage in substance free
recreation and leisure to assist in developing skills for wellness and
recovery.
Leo’s Youth Peer Advocate also helps Leo start to explore available Adult
services as he will soon be eligible for them.
37March 22, 2019
Modality Face-to-face
• Individual
• Group
• Group not to exceed 8 members total
• Group composition of members should share common
characteristics, such as related experiences, developmental age,
chronological age, challenges or treatment goals. The service is
directed to the child/youth and includes contacts necessary for
treatment with the family/caregiver or other collateral supports.
38March 22, 2019
Staff QualificationsYouth Peer Advocates (YPAs) must complete the Youth Peer Support Services
Council recommended and State Approved Level One and Level Two YPA training
or comparable training that has been approved by the Youth Peer Support Services
Council and State.
Specific components of Level One and Level Two can be found on the Families
Together in NYS web site (www.ftnys.org) or CTAC (www.ctacny.org)
OR
For the Credentialed Recovery Youth Peer Advocates (CRPA-Y): Complete a
minimum of 46 hours of content specific training, covering the topics: advocacy,
mentoring/education, recovery/wellness support, and ethical responsibility and 16
hours in the area of Youth Peer Support.
39March 22, 2019
Provider Qualifications
• Agencies must be designated through the NYS Children’s Provider
Designation Review Team. This requires agencies have appropriate
license, certification, and/or approval in accordance with State
designation requirements.
40March 22, 2019
Limitations and ExclusionsThe following activities are not reimbursable for Medicaid peer support programs:
• 12-step programs run by peers;
• General outreach and education including participation in health fairs, and other
activities designed to increase the number of individuals served or the number of
services received by individuals accessing services; community education services,
such as health presentations to community groups, PTAs, etc.;
• Contacts that are not medically necessary;
• Time spent doing, attending, or participating in recreational activities;
• Services provided to teach academic subjects or as a substitute for educational
personnel such as, but not limited to, a teacher, teacher's aide, or an academic tutor;
• Time spent attending school (e.g., during a day treatment program), with the exception
of attending meetings (e.g. CSE) with a Youth
41March 22, 2019
Limitations and Exclusions (Continued)• Habilitative services for the beneficiary (youth) to acquire self help, socialization, and adaptive
skills necessary to reside successfully in community settings;
• Child Care services or services provided as a substitute for the parent or other individuals
responsible for providing care and supervision;
• Respite care;
• Transportation for the beneficiary (youth) or family. Services provided in the car are considered
transportation and time may not be billed under rehabilitation;
• Services not identified on the beneficiary’s authorized service plan;
• Services not in compliance with the service manual and not in compliance with State Medicaid
standards;
• Services provided to children, spouse, parents, or siblings of the eligible beneficiary under
treatment or others in the eligible beneficiary’s life to address problems not directly related to
the eligible beneficiary’s issues and not listed on the eligible beneficiary’s treatment plan;
• Any intervention or contact not documented or consistent with the approved treatment/recovery
plan goals, objectives, and approved services will not be reimbursed.
42March 22, 2019
Crisis Intervention
43March 22, 2019
What is Crisis Intervention?
• Mobile services provided to children/youth under age 21 who are identified as
experiencing an acute psychological/emotional change which results in a marked
increase in personal distress and which exceeds the abilities and the resources of
those involved (e.g. family, provider, community member) to effectively resolve it.
44March 22, 2019
What is Crisis Intervention?• As designated Crisis Intervention providers increase their capacity the state will provide a list of Crisis
Intervention Providers with hours of availability. For crises that occur outside of provider availability the
child/family will be directed to utilize other community resources (ex. Mobile crisis, local crisis hotlines and
emergency services)
• A crisis intervention episode begins with the provider’s initial face to face contact with the child.
• Care coordination is provided and must include, at a minimum, a follow up contact either by phone or in
person, to assure the child’s continued safety and confirm that linkage to needed services has taken place.
• Follow up may, include further assessment of mental status and needs, continued supportive intervention (face
to face or by phone, as clinically indicated), coordination with collateral providers, linkage to services or other
collateral contacts.
• The end of the CI episode will be defined by the resolution of the crisis and alleviation of the child/youth’s acute
symptoms, and/or upon transfer to the recommended level of care.
• The crisis intervention and follow up should not exceed 72 hours. If exceeding 72 hours, it shall be considered
a new CI episode and should be transferred to longer-term rehabilitative supports and services.
45March 22, 2019
Crisis Intervention Team• CI services are provided through a multi-disciplinary team to enhance engagement and meet the unique needs of the
child/youth and family.
• Teams are encouraged to include a range of service providers to promote the multi-disciplinary approach.
• The team should be comprised of at least two professionals for safety purposes.
• One member of a two-person crisis intervention team MUST be a licensed behavioral health professional and have
experience with crisis intervention service delivery including:
• Psychiatrist, Physician, Licensed Psychoanalyst, Licensed Clinical Social Worker, Licensed Master Social Worker,
Licensed Mental Health Counselor, Licensed Psychologist, Licensed Marriage and Family Therapist, or Nurse
Practitioner with experience/background in treatment of mental health and/or substance use disorders.
• The team may also be comprised of non-licensed behavioral health professionals to include:
• Certified Alcoholism and Substance Abuse Counselor, Credentialed Family Peer Advocate with lived experience as a
family member, Certified Recovery Peer Advocate-Family, Certified Rehabilitation Counselor, or Registered
Professional Nurse.
• If one member of the team is a Peer Advocate, the Peer Advocate must have a credential/certification as either an OMH
established Family Peer Advocate Credential or an OASAS established Certified Recovery Peer Advocate-Family
46March 22, 2019
Crisis Intervention Team• If determined through triage only one team member is needed to respond to a psychiatric
crisis, that team member MUST be a behavioral health professional and have experience
with crisis intervention.
• If determined through triage only one team member is needed to respond to a substance
use disorder (SUD) crisis, the team member may be a Credentialed Alcoholism and
Substance Abuse Counselor (CASAC) and a licensed behavioral health professional must
be available via phone.
• Substance use should be recognized and addressed in an integrated way as it elevates
risk and impacts both the crisis intervention being delivered and the planning for ongoing
care, further demonstrating the necessity of a multi-faceted team approach. As such, crisis
services cannot be denied based upon substance use and crisis team members should be
trained on screening for substance use disorders.
• A Peer Support specialist may not respond alone
47March 22, 2019
Crisis Intervention Service Components
Crisis Intervention may include the following components:
1. Assessment of risk, mental status and need for further evaluation and/or
other health/behavioral health services.
2. Crisis Planning. The crisis planning minimally addresses:
• Immediate safety/risk concerns,
• Prevention of future crises,
• Signing of appropriate consent for releases for follow up referrals to
services and/or collaboration with existing providers of recipients.
48March 22, 2019
Crisis Intervention Service Components
3. Care Coordination, including:
• Consultation with a physician or other licensed practitioner of the healing arts to assist with the
child’s specific crisis and planning for future service access,
• Contact with collaterals focusing on the child’s needs,
• Follow-up with the child and family/caregiver within 24 hours of initial contact/response, including
informing existing supports/providers of the developed crisis plan,
• Documentation of follow-up services.
4. Crisis resolution and debriefing (counseling) with child and/or family/caregiver and
treatment provider.
5. Peer Support, assisting in the resolution of issues through instilling confidence
and support.
49March 22, 2019
Why offer Crisis Intervention?
• CI services are designed to interrupt or ameliorate the crisis experience and
result in immediate crisis resolution.
• The goals of CI are:
• Engagement,
• Symptom reduction,
• Stabilization, and
• Restoring child/youth to a previous level of functioning, or promoting
coping mechanisms within the family unit to minimize or prevent crises in
the future.
50March 22, 2019
Crisis Intervention Example• George experiences a crisis situation that exceeds the resources of the
caregiver in the home. The caregiver calls the Crisis Provider and explains
the crisis situation. It is determined through the triage phone call that George
is experiencing an acute behavioral health crisis.
• Crisis team of two (one LMSW and one Family Peer Advocate) goes the
home to help de-escalate the crisis and reinforce the safety plan established
in the plan of care. After the crisis situation has passed, the CI team has
discovered through the conversation that George has a regularly scheduled
counseling appointment the next day and there is no need for additional
resources prior to this appointment.
• A follow up call later from the CI provider discusses with the family the crisis
situation, tips for promoting coping mechanisms, reducing future crises.
51March 22, 2019
Modality
• All service components are meant to be provided by individual face-
to-face intervention with the child and their caregiver/collaterals.
• Follow-up may be conducted in person or by phone.
52March 22, 2019
Staff QualificationsFor service components 1-4 (Assessment, Crisis Planning, Care Coordination, Crisis Resolution and
Debriefing):
• Psychiatrist,
• Physician,
• Licensed Psychoanalyst,
• Licensed Clinical Social Worker (LCSW),
• Licensed Master Social Worker (LMSW),
• Licensed Mental Health Counselor,
• Licensed Psychologist,
• Licensed Marriage and Family Therapist
• Nurse Practitioner with experience/background in treatment of mental health and/or substance use disorders,
• Certified Alcoholism Substance Abuse Counselor,
• Certified Rehabilitation Counselor, or
• Registered Professional Nurse.
For service component 4 (Crisis Resolution and Debriefing):
• Credentialed Family Peer Advocate with lived experience as a family member
• Certified Recovery Peer Advocate-Family
53March 22, 2019
Staff Qualifications Continued
For service component 5 (Peer Support):
• NYS Credentialed Family Peer Advocate (FPA) or a Certified Recovery Peer
Advocate-Family (CRPA-F)
• A Peer Advocate may not respond alone.
• If one member of the crisis intervention team is a Peer Advocate, the
Peer support provider must have a credential/certification as either:
1) an OMH established Family Peer Advocate, or
2) an OASAS established Certified Recovery Peer Advocate-Family.
• Services should be provided by a competent, trauma-informed, and
linguistically responsive multidisciplinary team, for programmatic and safety
purposes
54March 22, 2019
Provider Qualifications
• Agencies must be designated through the NYS Children’s Provider
Designation Review Team. This requires agencies have appropriate license,
certification, and/or approval in accordance with State designation
requirements.
March 22, 2019
HCBS Eligibility and Crosswalk of Services
56March 22, 2019
HCBS Eligibility• HCBS LOC Eligibility Determination has three components
• Target Population Criteria (SED, MF, DD-MF, FC-MF, FC-DD, FC-SED),
• Risk Factors, and
• Functional Criteria
• The HCBS/LOC Determination will be within the Uniform Assessment System
(UAS) which also houses the CANS-NY
* On Wednesday March 13, 2019 from 1 to 2:30 pm a webinar was presented
regarding the new Home and Community Based Services (HCBS) Level of Care
(LOC) Eligibility Determination.
57March 22, 2019
Who Does What?
• Health Home Care Management
• State Designated Entity
• Developmental Disabilities
Regional Offices (special
circumstances only)
HCBS/LOC Eligibility Determination within the UAS
• HCBS Provider, informed by
• Any completed service
assessment/intake process
performed by the HCBS provider
• Person centered planning
discussion between the child,
family and HCBS provider in
development of a service plan
• Established goals
Establishment of Frequency/Scope/Duration
56
Transition Step – Plan of Care Services Crosswalk
March 22, 2019
57
Continue Step – Plan of Care Services Crosswalk
March 22, 2019
60
Accessibility Modifications
Child Transitioning from OCFS B2H Waiver to HCBS
OCFS Adaptive and Assistive Equipment B2HWaiver
Adaptive and Assistive Equipment
Environmental Modification
Vehicle Modification
March 22, 2019
59
Children and Family Treatment Support and Services
OCFS B2HWaiver
Crisis Avoidance, Management CPST
& Training
Immediate Crisis Response Services
CPST, OLP: Crisis Component,
**Crisis Intervention
Skill BuildingPSR
*From 4/1/2019 through 6/30/2019 Family Peer Support Services will be authorized under the Children 1915c waiver for ALL children who are HCBS eligible. From 4/1/2019- 12/31/2019 Youth Peer Supports will be authorized under the Children 1915c waiver for all children who are HCBS eligible. Both services will be provided by designated providers identified with the interagency designation team and delivered consistent with the service descriptions and staff/provider qualifications outlined in HCBS provider manual found here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/draft_hcbs_manual.pdf**Crisis Intervention as defined in the HCBS provider manual expands the qualifications, requirements and description of services beyond what today’swaiver provides.
March 22, 2019
62March 22, 2019
Child Transitioning from OMH Waiver to HCBS
OMH SED WAIVER
Individualized Care Coordination
Respite Services
Prevocational Services
Supported Employment
Health Home
Respite: Crisis and Planned
PrevocationalServices
Supported Employment
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Child Transitioning from OMH Waiver to CFTSS Services
OMH SED WAIVER
Crisis Response ServicesCPST, OLP: Crisis Component,
**Crisis Intervention
Intensive In Home Service CPST
Family Peer Support Services*FPSS
Youth Peer Advocacy and Training
Skill *YPS
Building PSR
*From 4/1/2019 through 6/30/2019 Family Peer Support Services will be authorized under the Children 1915c waiver for ALL children who are HCBS eligible. From 4/1/2019- 12/31/2019 Youth Peer Supports will be authorized under the Children 1915c waiver for all children who are HCBS eligible. Both services will be provided by designated providers identified with the interagency designation team and delivered consistent with the service descriptions and staff/provider qualifications outlined in HCBS provider manual found here:https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/draft_hcbs_manual.pdf**Crisis Intervention as defined in the HCBS provider manual expands the qualifications, requirements and description of services beyond what today’swaiver provides.
March 22, 2019
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65March 22, 2019
NYS Allowable Billing Combinations For Children’s Behavioral Health, Children and Family Treatment and Support Services and HCBS
NYS Allowable Billing Combinations of Children’s Behavioral Health, Children and Family Treatment and Support Services and HCBS
HCBS/State Plan
Services
OMH Clinic OASAS Clinic OASAS Opioid
Treatment
Program
OMH ACT* OMH PROS* OMH CDT* OMH Partial
Hospital
OASAS
Outpatient
Rehab
CPST / OLP PSR FPSS YPST
Day HabilitationYes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
Community
Habilitation
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Caregiver & Family
Support and
Services
Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
Respite Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesPrevocational
Services
Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
Supported
Employment
Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
Community Self-
Advocacy Training
and Supports
Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
Other Licensed
Practitioner (OLP)
Yes** No No Yes No No Yes No Yes Yes Yes Yes
Community
Psychiatric
Supports and
Treatment (CPST)
Yes Yes Yes No No No Yes Yes - Yes Yes Yes
Psychosocial
Rehabilitation
(PSR)
Yes Yes Yes No No No Yes Yes Yes - Yes Yes
*These services available to youth age 18 and older
**OMH guidance is forthcoming to avoid duplication in services.
66March 22, 2019
NYS Allowable Billing Combinations For Children’s Behavioral Health,
Children and Family Treatment and Support Services and HCBSNYS Allowable Billing Combinations of Children’s Behavioral Health, Children and Family Treatment and Support Services and HCBS
HCBS/State Plan
Services
OMH
Clinic
OASAS Clinic OASAS Opioid
Treatment
Program
OMH ACT* OMH PROS* OMH CDT* OMH Partial
Hospital
OASAS
Outpatient
Rehab
CPST/OLP PSR FPSS YPST
Youth Peer Support
and Training
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes -
Family Peer SupportYes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes -
Crisis InterventionYes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
Palliative Care
Pain & Symptom
Management
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Palliative Care
Bereavement
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Palliative Care
Massage Therapy
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Palliative Care
Expressive Therapy
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Accessibility
Modifications
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Adaptive and
Assistive Equipment
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
*These services available to youth age 18 and older
67March 22, 2019
Tools Select the Tools Tab at www.mctac.org
Billing Tool – Children System specific
updates. https://billing.ctacny.org/
Glossary of Terms- Interactive online glossary of
frequently used managed care terminology.
Includes a printable top acronyms "cheat sheet.”
https://glossary.ctacny.org/
Managed Care Plan Matrix – comprehensive resource
for MCO contact information relevant to adults and
children. https://matrix.ctacny.org/
68March 22, 2019
Resources and InformationProvider List https://pndslookup.health.ny.gov/
List of NYS Health Homes by County
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm
C-YES
Contact info: 1-833-333-CYES (1-833-333-2937); TTY: 1-888-329-1541
https://nymedicaidchoice.com/information-care-management-agencies
Children’s Behavioral Health Transition to Managed Care
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm
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Email Resources Please specify if kids system/managed care specific in subject line:
DOH Transition Mailbox
NYS OMH Managed Care Mailbox
NYS OASAS Mailbox:
NYSDOH Health Homes for Children:
NYS OCFS Mailbox:
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Questions
Please send questions to: [email protected]
Logistical questions usually receive a response in 1 business day or less.
Longer & more complicated questions
can take longer.
We appreciate your interest and patience!
Visit www.mctac.org to view past trainings, sign-up for updates and event announcements, and access resources