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

  • A notice has been released to inform Children’s Waiver HCBS Respite providers of changes to Planned and Crisis Respite rates. These revisions include an adjustment to the rate structure that better aligns with service provision.  Providers should refer to the Children’s Home and Community Based Services Provider Manual and the New York State Children’s Health and Behavioral Health Services Billing and Coding Manual for additional guidance on the standards for delivering these services to children/youth enrolled in the Children’s Waiver. The updated Children’s HCBS Rate Summary can be found here: HCBS Rate Summary – (Web) – (PDF) – March 11, 2021

  • The State has released additional policies to support Children’s Waiver Home and Community Bases Services (HCBS).  Attached is a list of policies, release dates, effective dates, and applicable parties – Health Homes Serving Children (HHSC)/Care Management Agencies (CMAs), HCBS Providers, or both. The State will be conducing training on these policies in January-March 2021.  – December 31, 2020
  • Children´s Medicaid and Behavioral Health System Transformation Updates – Issue #6 – December 2020 (PDF)
  • In accordance with the FY21 Enacted Budget, the enclosed rate amendments for Children and Family Treatment and Support Services (CFTSS) have been approved by New York State. These rate changes implement an MRT II initiative extending transitional rates for CFTSS for two years. The attached guidance memo outlines the changes to rates for each service and the timeframe for those changes.
  • 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:

    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: 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:
  • The DOH’s Children’s Behavioral Health webpages have been continuously updated to ensure providers, Health Homes and Managed Care Plans have relevant information:
  • 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:
  • 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.

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: