Children’s System: Home and Community Based … Series...Friday, March 22, 2019 Service Specific Webinar 4: Family Peer Support Services, Youth Peer Support and Training, & Crisis

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

61

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

62March 22, 2019

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

69March 22, 2019

Email Resources Please specify if kids system/managed care specific in subject line:

DOH Transition Mailbox

[email protected]

NYS OMH Managed Care Mailbox

[email protected]

NYS OASAS Mailbox:

[email protected]

NYSDOH Health Homes for Children:

[email protected]

NYS OCFS Mailbox:

[email protected]

70March 22, 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.mctac.org to view past trainings, sign-up for updates and event announcements, and access resources