Children’s System Transformation

Children’s Medicaid Health and Behavioral Health System Transformation

Transformation of the Children’s Medicaid Health and Behavioral Health System is scheduled to begin on January 1, 2019. Key Components of the Transformation, pending federal approval, include:

Transition of six 1915(c) waivers to 1115 Waiver authority

• Office of Mental Health (OMH) Serious Emotional Disturbance (SED) Waiver;
• Department of Health (DOH) Care at Home (CAH) I/II waiver
• Office for People with Developmental Disabilities (OPWDD) Care at Home Waiver
• Office of Children and Families (OCFS) Bridges to Health (B2H) SED, Developmental
Disability (DD) and Medically Fragile Waivers

Alignment of 1915(c) HCBS under one array of Home and Community Based Services (HCBS) authorized under 1115 Waiver

Transition to Health Home Care Management

• Current 1915(c) Waiver Providers Transition to Health Home
• Care Management provided under 1915(c) Transition to Health Home Care Management

1915c Wavier Providers (OCFS B2H, OMH SED, OPWDD CAH and DOH CAH)

As outlined in the transition in-person training, a number of resources will be provided for 1915c waiver providers to assist you and the children and families you serve to transition to Health Home care management during the transition period of January 1, 2019 through March 31, 2019. Below is a list of each resource and a brief description.

1. In-Person 1915c Transition to HH Training

2. Talking Points for Transitioning 1915c Waiver Providers: Script for talking to families about the upcoming transition.

3. Direct Noticing Draft Schedule: Tentative schedule for messages from the State and Managed Care Plans for recipients and families.

4. FAQ for Care Managers: Frequently asked questions for CMs about 1915c children’s waiver home and community based services.

DOH Resources

The New York State Children’s Health and Behavioral Health Services Billing and Coding Manual has been updated. Attached, you will find an updated copy of this manual along with the Guide to Edits Included in the New York State Children’s Health and Behavioral Health Billing and Coding Manual. The complete manual can also be found on the Department of Health website at:
- Guide to Edits Included in the New York State Children’s Health and Behavioral Health Billing and Coding Manual – Version 2020-1 September 10, 2020
- New York State Children’s Health and Behavioral Health Services Billing and Coding Manual – Version 2020-1 September 10, 2020
The Children and Family Treatment and Support Services Provider Manual for EPSDT has been updated. The CFTSS manual is also attached and can be found on the Department of Health website at:
- Children and Family Treatment and Support Services Provider Manual for EPSDT Services – (PDF) – Updated September 14, 2020
Children’s Waiver Appendix K UPDATED FAQ to Address HCBS COVID-19 Questions – August 28, 2020
An UPDATED FAQ to Address additional HCBS COVID-19 Questions that have been received regarding how to managed the Children’s Waiver processes during COVID-19 can be found on the 1915(c) Children’s Waiver and 1115 Waiver Amendments webpage and the appendix Ks and FAQ can be found under the 1915c Children’s Waiver Amendment tab.
HCBS Provider De-Designation Procedure – August 27, 2020
A new De-Designation Procedure for Children’s Waiver providers has been developed to ensure a more accurate list of available providers. NYS Children’s Team is hoping that with an accurate list of designated providers, we can better identify gaps of service providers and assist referring entities in connecting with available providers able to take referrals.

All HCBS policies, procedures, and the HCBS Manual can be found here: https://health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/1115_waiver_amend.htm under the HCBS Provider Manual, Policies, and Rates tab.
The attached notice is to clarify recent changes to Medicaid rates for children/youth services, as a result of the SFY 2020-21 Enacted Budget and to explain the impact of Across the Board (ATB) reductions to Medicaid payments on children/youth services. – August 26, 2020
Requirements for Service Providers Delivering Children and Family Treatment and Supports Services (CFTSS) and Children’s Home and Community Based Services (HCBS) and Working Collaboratively with Providers – March 30, 2020
Children´s Medicaid and Behavioral Health System Transformation Update #5 – January 2020
The following information is a Step by Step Process for Health Home Care Managers to follow when a child/youth request to transfer from either the Children’s Waiver to the OPWDD Comprehensive Waiver or from the OPWDD Comprehensive Waiver to the Children’s Waiver. Please be sure to review the steps prior to moving forward with trying to transfer a child/family to ensure there are no gap in services. Link: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/transfer_process_childrens_and_opwdd_comprehensive_waiver.pdf
The DOH’s Children’s Behavioral Health webpages have been continuously updated to ensure providers, Health Homes and Managed Care Plans have relevant information: https://health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm
Specific to the Children’s Waiver, a number of tabs have been added to assist with the location of information such as HCBS Provider Manual, Eligibility Forms, Plan of Care and OPWDD Resources to name a few: https://health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/1115_waiver_amend.htm
NYS and MCTAC have worked with Medicaid Managed Care Plans (MMCPs) to update the CFTSS Authorization Grid* outlining MMCP-specific notification and concurrent authorization requirements, as well as contact information for Utilization Management (UM) staff for CFTSS-related questions and authorizations. This update includes information for Family Peer Support Services, which were implemented in the State Plan as of July 1, 2019.
NYS is releasing the first in a series of outreach materials on the new Children’s Home and Community Based Services that began on April 1, 2019 through the consolidated 1915(c) Children’s Waiver. This brochure is available online and can be downloaded, printed, and shared by all stakeholders for use in their outreach to children, youth, and families who may be in need of these services. Translated versions in Arabic, Chinese, French, Haitian-Creole, Italian, Korean, Russian, Spanish, and Urdu will be available soon.
The State has updated several documents on the Children’s Behavioral Health Transition to Managed Care website ( https://health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm ) in response to Stakeholder input reflecting approval dates, new timeline dates and additional guidance. – April 8, 2019
The amendment that consolidates and administratively aligns all of New York’s six 1915(c) Home and Community Based Medicaid children’s waivers into one waiver, which will now be referred to as “The Children’s Waiver- NY.4125” is approved effective April 1, 2019.
Due to a number of questions from various stakeholders regarding the difference between a Plan of Care, Service Plan and Treatment Plan, the following guidance was developed. – March 27, 2019
https://health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/services_access_documentation.pdf https://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_children/docs/services_access_documentation.pdf
Update to Children’s Managed Care Transition Timeline – March 11, 2019
Children’s Transition Timeline – March 11, 2019
Slides from the Children’s Medicaid Transformation Update: Transition to Health Home Care management and Children’s Waiver Webinar held on Wednesday February 13, 2019.
The State has updated two key documents for the Children’s Medicaid System Transformation:
1. Children’s Health and Behavioral Health Services Transitional Billing Supplement: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/nys_child_trans_bill_supp.pdf
2. Children’s Home and Community Based Services Provider Manual: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/draft_hcbs_manual.pdf
Document on Required Steps to be Completed for the Transition of 1915(c) Waiver Care Coordination to Health Home Care Management or the Independent Entity Under the Children’s Medicaid Transformation.
Updated guidance surrounding the specifics to transition children from current HCBS to Children and Family Treatment and Support Services (CFTSS). Due to provider feedback, the time period to transition children to CFTSS has been extended to January 31, 2019 11:59 pm.
The Children and Family Treatment and Support Services (CFTSS) brochure is now available in nine additional languages. All translations are posted with the English brochure to the OMH Children’s Transition Webpage. These languages include:
- Arabic
- Traditional Chinese
- French
- Haitian-Creole
- Italian
- Korean
- Russian
- Spanish
- Urdu
Children’s MRT Subcommittee Quarterly Meeting – September 26, 2018
Webinar recording for the Children’s Behavioral Health Provider Readiness Funds – August 2, 2018
NYS Children’s Health and Behavioral Health Services Billing and Coding Manual – July 26, 2018
NYS Children’s Health and Behavioral Health Services Transitional Billing Supplement – July 26, 2018
Children’s Medicaid System Transformation: SPA Rate Review – July 2, 2018
Children´s Medicaid and Behavioral Health System Transformation Updates #3 – July 2018
Designated Children’s providers for the new Children and Family Treatment and Support Services and Aligned Home and Community Based Services – June 27, 2018
Children’s MRT Subcommittee Quarterly Meeting – June 25, 2018
Children´s Medicaid and Behavioral Health System Transformation Updates #2 – June 2018
Children’s Medicaid System Transformation Draft HCBS Workflow for Stakeholder Comment – May 23, 2018
Children’s Medicaid System Transformation: SPA Rate Review – May 14, 2018
Children´s Medicaid and Behavioral Health System Transformation Updates #1 – May 2018
New Background Checks and Other Requirements for Health Home Care Managers and Children’s 1115 Waiver HCBS Providers – April 2018
DRAFT Transition Plan for the Children’s Medicaid System Transformation – August 2017
Additional details on the Transformation are available on the DOH Web Site.

NYS Council Advocacy

The NYS Council has been an active member of the Children’s Behavioral Health MRT Committee and has been providing comments all along the way related to the transformation. Specifically, we have submitted the following comment letters:

July 27, 2018 – Comments on Children’s Transformation Training Plan
July 18, 2018 – Comments on Updated Provider Manual for Children and Family Treatment and Support Services
July 18, 2018 – Comments on Updated SPA Rates
May 30, 2018 – Comments on HCBS Work Flow and Proposed SPA Rate Revisions
April 4, 2018 – Comments on Children’s Reform
October 16, 2017 – Comments on NYS Value-Based Payment for Children
April 5, 2017 – Comments on Draft Children’s System Transition Requirements and Qualification Standards for Mainstream Medicaid Managed Care Organizations (MMCOs)