children’s system: aligned home and community based ... series webinar 1 caregive... · •...
TRANSCRIPT
March 1, 2019
Service Specific Webinar 1: Caregiver/Family Supports and Services, Community Self-Advocacy Training and Supports, & Respite
Children’s System: Aligned Home and Community Based Services (HCBS)
2March 1, 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 1, 2019
Agenda
• HCBS Overview of Key Concepts
• Caregiver/Family Supports and Services
• Community Self-Advocacy Training and Supports
• Respite
• HCBS Eligibility and Crosswalk of Services
4March 1, 2019
HCBS Overview of Key Concepts
5March 1, 2019
Overview of Children’s HCBS Waiver 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
• Home and Community Based Services will be billed Fee for Service and not in managed care
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
6March 1, 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 to come.
7March 1, 2019
Core Principles
8March 1, 2019
HCBS SettingsAllowable 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.
9March 1, 2019
Billing HCBS between
April 1 and September 30, 2019
• Children’s HCBS waiver will be billed Fee for Service (FFS) for all children enrolled in the Children’s Waiver.
10March 1, 2019
Billing 101: beginning October 1, 2019
Medicaid Managed Care (MMC) carve inFundamentals
• If child in 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 not in MMCP – bill Fee-For-Service
11March 1, 2019
Caregiver/Family Supports and Services
12March 1, 2019
What are Caregiver/Family Supports and Services?Based upon the Caregiver/Family Supports and Services plan developed by the child/youth and
caregiver/family team, this service provides opportunities to:
• Interact and engage with family/caregivers and children/youth to offer educational, advocacy,
and support resources to develop family/caregivers’ ability to independently access
community services and activities;
• Maintain and encourage the caregivers’/families’ self-sufficiency in caring for the child/youth
in the home and community;
• Address needs and issues of relevance to the caregiver/family unit as the child/youth is
supported in the home and community;
• Educate and train the caregiver/family unit on resource availability so that they might better
support and advocate for the needs of the child and appropriately access needed services;
• Direct instruction and guidance in the principles of children’s chronic condition or life
threatening illness.
Note: This service is not the State Plan service of Family Peer Support Services which is
required to be delivered by a certified/credentialed Family Peer with lived experience.
13March 1, 2019
Why Offer Caregiver/Family Supports and Services?• Enhance the child/youth’s ability regardless of disability (developmental,
physical and/or behavioral) to function as part of a caregiver/family unit
• Enhance the caregiver/family’s ability to care for the child/youth in the home
and/or community
• Family is broadly defined, and can include families created through: birth,
foster care, adoption, or a self-created unit.
14March 1, 2019
Caregiver/Family Supports and Services Example
Jamil is a 7 year old struggling with significant impulse control issues impacting school performance and peer relationships. His father is concerned about him maintaining his school placement and is worried that he doesn’t have any friends.
The Caregiver/Family Support provider helps Jamil’s father connect with community resources and helps him understand and participate in school meetings effectively. The provider works with Jamil in his afterschool program to maintain and strengthen his age appropriate independence in the community.
15March 1, 2019
Modality• Individual face to face intervention
• Group face to face intervention (no more than 3 HCBS eligible children/families)
16March 1, 2019
Limitations/Exclusions• This service cannot be delivered nor billed while an enrolled child is in an in-
eligible setting, including hospitalization
• Special education and related services that are otherwise available to the individual through a local educational agency, under the provisions of the Individuals with Disabilities Education Act (IDEA)
• Caregiver Family Supports and Services are limited to three hours per day
17March 1, 2019
Staff Qualifications• Minimum: High school diploma, high school equivalency preferred or a
State Education Commencement Credential (e.g. SACC or CDOS) with
related human service experience
• Preferred: Experience working with children/youth
18March 1, 2019
Supervisor Qualifications• Minimum: Qualification of a Bachelor’s degree with one year experience in
human services working with children/youth
• Preferred: Qualification of a Bachelor’s degree with two years experience in
human services working with children/youth
19March 1, 2019
Community Self-Advocacy Training and Supports
20March 1, 2019
What is Community Self-Advocacy Training and Supports?• Provides family, caregivers, and collateral contacts with techniques and
information so that they can better respond to the needs of the child/youth.
• Training for the child/youth and/or the family/caregiver regarding methods
and behaviors to enable success in the community.
• Direct self-advocacy training in the community with collateral contacts
regarding the child/youth’s disability(ies) and needs related to his or her
health care issues.
• Self-advocacy training for the child/youth and/or family/caregiver, including
during community transitions.
21March 1, 2019
Why Offer Community Self-Advocacy Training and Supports?• Assist the child/youth, family/caregiver, and collateral contacts in
understanding and addressing the child/youth’s needs.
• May be provided to support the child/youth experiencing difficulty in
community settings.
• Improves the child/youth’s ability to gain from the community experience,
and enables the child/youth’s environment to respond appropriately to the
child/youth’s disability and/or health care issues.
22March 1, 2019
Community Self-Advocacy Training and Supports Example
Charlotte, age 16, has been struggling with substance abuse issues and recently was admitted into a 30 day treatment program.
Charlotte and her parents are not familiar with available community supports that will support Charlotte’s recovery. The provider meets with Charlotte and her parents to provide assistance in accessing the appropriate community resources as well as provides guidance around system navigation.
23March 1, 2019
Modality• Individual face to face intervention
• Group face to face intervention (no more than 3 HCBS eligible children/youth)
24March 1, 2019
Staff Qualifications• Minimum: An individual employed by the agency with a bachelor’s degree
plus two years of related experience
• Preferred: An individual employed by the agency with a Master’s degree in
education, or a Master’s degree in a human services field plus one year of
applicable experience
25March 1, 2019
Supervisor Qualifications• Minimum: Qualifications of a Master’s degree with one year experience in
human services working with children/youth
• Preferred: Qualifications of a Master’s degree with two years of experience
in human services working with children/youth
26March 1, 2019
Respite
27March 1, 2019
What is Respite?
• Short-term assistance provided to children/youth regardless of disability
(developmental, physical and/or behavioral) due to the absence of, or need
for, relief of the child or the child’s family caregiver.
• Such services can be provided in a planned mode or delivered in a crisis
situation.
• Respite workers supervise the child/youth and engage the child/youth in
activities that support his/her and/ or primary caregiver/family’s constructive
interests and abilities.
28March 1, 2019
Why Offer Respite?
• Offer services with a level of expertise in understanding and implementing
behavioral/developmental interventions required to support optimal
functioning for children/youth.
• Through communication of the details of the child/youth’s intervention plan
there is a carryover of skill from the respite source to the caregivers and
treatment providers.
29March 1, 2019
Respite Service Components
• Planned
• Crisis
30March 1, 2019
Planned Respite• Short-term relief for the child or family/primary caregivers that are needed to
enhance the family/primary caregiver’s ability to support the child/youth’s
functional, developmental, behavioral health and/or health care needs.
• This service is direct care for the child/youth by individuals trained to support
the child/youth’s needs.
• This may occur in short-term increments of time (usually during the day) or
on an overnight or longer-term increment.
• Planned Respite activities support the plan of care goals and include
providing supervision and activities that match the child/youth's
developmental stage and continue to maintain the child/youth health and
safety.
31March 1, 2019
Crisis Respite
• Short-term care and intervention strategy for children/youth and their families
that helps to alleviate the risk for an escalation of symptoms, a loss of
functioning, and/or a disruption in a stable living environment.
• May be used when challenging behavioral or situational crises occur which the
child/youth and/or family/caregiver is unable to manage without intensive
assistance and support.
• Crisis Respite can also be used as a result of crisis intervention or from visiting
the emergency room.
• Crisis Respite should be included on the POC to the extent that it is an element
of the crisis plan or risk mitigation strategy.
32March 1, 2019
Crisis Respite Continued
• Services offered may include: site-based crisis residence, monitoring for high risk
behavior, health and wellness skill building, wellness activities, support to the
family/caregiver, conflict resolution, and other services as needed.
• At the conclusion of a Crisis Respite period, crisis respite staff, together with the
child/youth and family/primary caregiver, and his or her established behavioral health
or health care providers when needed, will make a determination as to the
continuation of necessary care and make recommendations for modifications to the
child’s plan of care. Children are encouraged to receive Crisis Respite in the most
integrated and cost-effective settings appropriate to meet their respite needs. Out of
home Crisis Respite is not intended as a substitute for permanent housing
arrangements.
33March 1, 2019
Respite ExamplesPlanned Respite: William is 12 years old. The respite provider takes William to a kickball game in Williams community. While at the kickball game the respite provider assists in helping William practice following the coach’s directions per his plan of care goal to improve his focus in and outside of the classroom.
Crisis Respite: On another occasion William’s grandmother calls the Respite provider because William is becoming aggressive and threatening to harm his family members. The Respite provider goes to the family’s home and engages William in utilizing his safety plan skills by practicing them together and reinforcing skills to help William deescalate. On this occasion the Respite provider and William utilize shooting hoops as an initial de-escalation technique till William is able to talk through what his needs are, why he is upset and how he will remain calm enough to not require more intensive interventions. William and his Grandmother are supported in this example.
34March 1, 2019
ModalityBoth Planned and Crisis Respite can be provided in the following ways:
• Planned Day/Overnight Respite: This service may be delivered with support of
staffing ratios necessary to keep the child, and other children in the environment,
safe and as indicated in the child’s POC overseen by the respite provider.
• Crisis Planned/Overnight Respite: This service may be delivered with support of
staffing ratios necessary to keep the child, and other children in the environment,
safe and as indicated in the child’s POC overseen by the respite provider.
35March 1, 2019
Limitations and Exclusions• Note: Services to children and youth in foster care must comply with Part 435 of 18
NYCRR Respite is not an allowable substitute for permanent housing arrangements.
• For respite services that may be provided as crisis or overnight, Federal Financial
Participation is not claimed for the cost of room and board except when provided as
part of respite care furnished in a facility approved by the State that is not a private
residence.
• Please note: It is the responsibility of the Care Coordinator upon referral to ensure that
respite providers have adequate training and knowledge to address the individual
child/youth’s needs (including but not limited to physical and/ or medical needs such as
medications or technology), OR have made arrangements for an appropriately trained
and knowledge individual to address the individual child/youth’s needs (including but
not limited to physical and/ or medical needs such as medications or technology.
Examples include arrangement of approved Private Duty Nurse for a technology
dependent child while in a respite setting.
36March 1, 2019
Staff Qualifications in Child’s residence or other community based setting (e.g. park, shopping center, etc..)
• Respite providers are paraprofessionals with a high school diploma or
equivalent and with appropriate skills and training. It is the responsibility of the
Care Coordinator to ensure that providers have adequate training and
knowledge to address the individual child’s needs (including but not limited to
physical and/ or medical needs such as medications or technology).
• has experience working with children/youth (preference given to those with
experience working with children/youth with special needs);
• a high school diploma, high school equivalency preferred or a State
Education Commencement Credential (e.g. SACC or CDOS).
37March 1, 2019
Staff Qualifications outside child’s residence and in an allowable licensed/certified setting
• In a foster boarding home: Respite providers must be a Licensed Foster Parent pursuant to Part 435 of 18 NYCRR
• In an OCFS licensed/certified setting: Respite providers are paraprofessionals with a high school diploma or equivalent and with appropriate skills and training. Settings include an agency boarding home, a group home, a group residence, or an institution
• In an OMH-certified Community Residence (community-based or state operated), including Crisis Residence, which has an OMH Operating Certificate demonstrating compliance with 14 NYCRR 594: Respite workers must be staff of the licensed program
• In an OPWDD-certified setting: (community-based or state operated), Family Care Home; Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF/IDD); Individualized Residential Alternative (IRA); Community Residence (CR); or Free-Standing Respite facility under the auspices of OPWDD in compliance with 14 NYCRR Parts 633, 635 and 686
38March 1, 2019
Supervisor Qualifications
• Minimum: a Bachelor’s degree with one year experience in human services
working with children/youth
March 1, 2019
HCBS Eligibility and Crosswalk of Services
40March 1, 2019
HCBS EligibilityHCBS LOC Eligibility Determination has three components
• Target Population Criteria,
• Risk Factors, and
• Functional Criteria
• The HCBS/LOC Determination will be within the Uniform Assessment System (UAS) which also houses the CANS-NY
State will give additional presentation specifically on Aligned HCBS eligibility and Aligned HCBS capacity.
41March 1, 2019
Who does what?
42
42
March 1, 2019
43March 1, 2019
44
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 1, 2019
45
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 1115 for ALL children who are HCBS eligible. From 4/1/2019-12/31/2019 Youth Peer Supports will be authorized under the 1115 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 the CFTSS provider manual found here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/updated_spa_manual.pdf**Crisis Intervention as defined in the CFTSS provider manual expands the qualifications, requirements and description of services beyond what today’swaiver provides. Crisis Intervention as described in the CFTSS manual is scheduled for implementation on 1/1/2020.
March 1, 2019
46
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
March 1, 2019
47March 1, 2019
OMH SED WAIVER
Crisis Response Services
Intensive In Home Service
Family Peer Support Services
Youth Peer Advocacy and Training
Skill Building
*YPS
PSR
CPST
*FPSS
CPST, OLP: Crisis Component,**Crisis Intervention
Child Transitioning from OMH Waiver to CFTSS Services
*From 4/1/2019 through 6/30/2019 Family Peer Support Services will be authorized under the 1915c for ALL children who are HCBS eligible. From 4/1/2019-12/31/2019 Youth Peer Supports will be authorized under the 1915c 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 the CFTSS provider manual found here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/updated_spa_manual.pdf**Crisis Intervention as defined in the CFTSS provider manual expands the qualifications, requirements and description of services beyond what today’s waiver provides. Crisis Intervention as described in the CFTSS manual is scheduled for implementation on 1/1/2020.
48March 1, 2019
49March 1, 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 Yes
Prevocational
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.
50March 1, 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
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
51March 1, 2019
Additional ResourcesC-YES
C-YES can be contacted at 1-833-333-CYES (1-833-333-2937); TTY: 1-888-329-1541
https://nymedicaidchoice.com/information-care-management-agencies
List of NYS Health Homes by County
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm
Provider List https://pndslookup.health.ny.gov/
Children’s Behavioral Health Transition to Managed Care
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm
Resources and Information
52March 1, 2019
Tools Select the Tools Tab at www.ctacny.org
Billing Tool – Children System specific
updates –coming soon!
Output to Outcomes Database – access to
standardized outcome measurement tools and
metrics (database) designed to facilitate and
improve use of evidence based practices.
Managed Care Plan Matrix – comprehensive resource
for MCO contact information relevant to adults and
children
53March 1, 2019
Email Resources Please specify if kids system/managed care specific in subject line:
NYS OMH Managed Care Mailbox
NYS OASAS Mailbox:
NYSDOH Health Homes for Children:
NYS OCFS Mailbox:
DOH Transition Mailbox
54March 1, 2019
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.ctacny.org to view past trainings, sign-up for updates and event announcements, and access resources