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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

NYS Office of Mental Health
Division of Children and Families
Home and Community-Based Services Guidance Documents

Table of Contents
Complete Listing of Changes and Revisions

100 Home And Community-Based Services Overview
   100.1 Background, Goals, Individualized Care, Target Population, Services, Stakeholders, Funding, (Criteria for Serious Emotional Disturbance (SED) (Updated January 2014)
   100.2 Waiver Expansion, Slot Allocations, ICC Agencies (Updated March 2014)
200 Establishing the HCBS Lead Agency and Subcontracted Services
   200.1 Selecting an Individualized Care Coordination (ICC) Agency Policy: Criteria for Selection of the ICC Agency (Updated April 2014)
   200.2 Developing a Provider Network: Criteria, Approval Process, Contracts
(Request for Services)
300 Roles, Responsibilities, Qualifications, Training Requirements
   300.1A Role and Responsibilities: ICC Agency
   300.1B ICC Agency Worker Safety Policy and Protocols 
   300.2 Role and Responsibilities: Local Government Units 
   300.3 Roles and Responsibilities: SPOA, DSS, OMH Field Office, OMH Parent Advisors
   300.4 Role, Qualifications, Training Requirements: Individualized Care Coordinators (Updated May 2012)
(Child Abuse Register information)
   300.5 Roles, Qualifications, Training Requirements: Subcontract Workers (Updated October 2013)
(Definition of Qualified Mental Health Staff Person)
400 The Case Record and Service Delivery Issues
   400.1  HCBS Waiver Service Plans: (Updated January 2014)
Strength Based Service Plans and the Child Assessment of Needs and Strengths (CANS),
Timeline for Completion of Service Plans,
Initial Service Plan Narrative and Budget, (Updated June 2011)
30 and 90 Day Review Narratives (Updated June 2011)

Goals and Objectives
(New Form June 2011)
   400.2 Safety Alert Plan
   400.3 Authorization for Release of Information
   400.4 Progress Notes: ICC , Subcontract Worker and Group Notes
   400.5 HCBS Waiver Discharge Plan and Aftercare Follow-Up Plan
   400.6 Flex Funds (Updated May 2012)
   400.7 Inpatient Stays for Waiver Enrollees
   400.8 Wait Lists
   400.9 Transportation
500 HCBS Waiver Enrollment, Related Medicaid Information, When to Begin Billing, Child Budget, Level of Care, Transfers, Disenrollment 
   500.1 HCBS Waiver Child Eligibility Criteria and Considerations,
Role and Contact Information for Operations Support Unit (OSU)
(Updated October 2013)
   500.2 Overview of HCBS Waiver Enrollment Process, Withdrawal from Waiver and Transmittals to OSU
When Billing Can Begin (Updated January 2014)
   500.3 HCBS Waiver Enrollment Process – Phase I: Financial and Clinical Screening (Financial Information and Level of Care forms)
Step #1: Referrals (Financial Information Sheet source)
Step #2: Screening
Step #3: Level of Care Determinations
   500.4 HCBS Waiver Enrollment Process – Phase II
Step #4: HCBS Waiver Application/Freedom of Choice
Step #5: The Medicaid Application
Step #6: Health Care Options
   500.5 HCBS Waiver Enrollment Process – Phase III
Step #7: The Initial Service Plan Requirement for Enrollment
Step #8: Instructions for Completing the Child's Service Plan Budget
Step #9: Approval of Initial Service Plan and Budget
Step #10: OSU Notice of Determination and When to Begin Billing
   500.6 Medicaid Recertification and Waiver Level of Care Recertification
   500.7 Transfers:
New County and New Provider
New County and Same Provider
Same County and New Provider
   500.8 Disenrollment and Notice of Termination from the HCBS Waiver (Updated March 2011)
   500.9 Fair Hearings Appeal Process
600 Billing for the HCBS Waiver
   600.1 Introduction When Billing Can Begin, Rate Code Guide
   600.2  Billing Rules for ICC's; Contact Definitions; Inpatient Stays; ICC Start-Up (Updated March 2011)
   600.3  Billing Rules for the Five Non-ICC Waiver Services: Family Support Services, Skill Building Services, and Respite Services; Intensive In-Home and Crisis Response: Rules for Bundled Rates (Updated December 2013)
   600.3A Waiver Billing Chart Guide
   600.4 Billing for Group Work (Updated May 2012)
700 Program Monitoring and Evaluation
   700.1 Monitoring and Evaluation Overview:
ICC Agency Site Visits; Agency Corrective Actions Plans
   700.2 ICC Agency to OMH Waiver Data Collection and Reports
(Annual Administrative Review Form)
   700.3 Medicaid Expenditure Reports
800 HCBS Waiver Forms and Reports Reference Guide (Updated January 2014)

Online version started January 2007.

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