How to Become a HCBS Provider in NY

April 30, 2024

Learn how to become a HCBS provider in NY: from Medicaid enrollment to maintaining compliance.

Becoming an HCBS Provider in NY

In New York, becoming a Home and Community Based Services (HCBS) provider can be a rewarding career choice for those interested in healthcare and community service. The process involves enrolling in Medicaid, submitting a detailed application, and meeting various compliance rules. This guide will outline the initial steps on how to become a HCBS provider in NY.

Medicaid Enrollment Requirements

Before a healthcare agency can deliver HCBS, they must first be enrolled in Medicaid in New York State. Adult BH HCBS services are available for individuals aged 21 and over enrolled in a Medicaid Managed Care (MMC) Health and Recovery Plan (HARP), and deemed eligible after completing the NYS Eligibility Assessment. Individuals enrolled in a Special Needs Plan (SNP) may also qualify for BH HCBS [2].

To enroll in Medicaid, healthcare agencies must complete the NY Medicaid Provider Enrollment Form and obtain further information on enrolling from the eMedNY website. Once successfully enrolled as a Medicaid provider, agencies must contact the provider designation team by email at OMH-Childrens-Designation@omh.ny.gov with a copy of their enrollment confirmation email. The Provider Designation Team will assess readiness to provide services and may issue a Formal Designation Letter.

Application Process Overview

After enrolling in Medicaid, the next step in becoming a HCBS provider is to submit a complete application containing all requirements and additional forms. Incomplete applications will be rejected and returned for correction. Therefore, it's crucial to ensure all information is accurate and all required documentation is included.

Once the application is submitted and approved, newly designated agencies must submit an Attestation Form to comply with all Children's HCBS rules and regulations. This includes signing and submitting the form initially and providing updated attestations every three years to assist in the re-designation process.

Understanding each step in the application process is essential for those asking 'how do I become a HCBS provider in NY?'. By following these guidelines, healthcare agencies can achieve HCBS provider status and start making a difference in their community.

Required Documentation

Becoming a Home and Community-Based Services (HCBS) provider in New York involves several steps, including the submission of required documentation. This process is vital in demonstrating an agency's compliance with all Children's HCBS rules and regulations.

Completing the Attestation Form

A crucial part of the designation process is the completion and submission of the Attestation Form. This form is a formal declaration of an agency's compliance with all Children's HCBS rules and regulations. It is available on the New York Department of Health (DOH) website and must be signed and submitted by newly designated agencies [1].

In addition to the initial submission, providers are required to submit an updated Attestation Form every three years. This ongoing attestation assists in the re-designation process, ensuring that agencies continue to uphold the standards set by the DOH.

Compliance with HCBS Rules

All Children's HCBS providers, including non-licensed or non-certified providers, are obligated to comply with all Children's HCBS rules and regulations. This is not limited to specific requirements outlined in the policy but encompasses all tenets of the Final Rule as outlined by the DOH.

Providers applying for and/or currently designated for Children's Waiver HCBS must maintain policies, procedures, and supporting documentation to confirm compliance with Final Rule standards.

After the compliance review, the DOH will continue to monitor providers' compliance with the Final Rule on an ongoing basis, including in the HCBS case record review process conducted yearly. Providers are required to attest to compliance with Final Rule standards every three years during the Children's Waiver re-designation process.

To demonstrate compliance with the Final Rule, providers must compile required documentation into a zip file, complete a Documentation Worksheet, and submit these documents to ChildrensWaiverFinalRule@health.ny.gov within three weeks from the date of receipt.

By understanding and adhering to these requirements, potential HCBS providers can navigate the application process more effectively, enhancing their chances of achieving a successful designation.

Provider Designation Process

After successfully enrolling as a Medicaid provider with COS 0268, the next step in the journey to becoming a Home and Community-Based Services (HCBS) provider in NY is to go through the provider designation process. This entails contacting the Provider Designation Team and, once they evaluate your readiness, receiving a Formal Designation Letter.

Contacting the Designation Team

Once you have completed Medicaid enrollment, you must contact the Provider Designation Team via email at OMH-Childrens-Designation@omh.ny.gov. In this email, include a copy of your enrollment confirmation from Provider Enrollment. This is the first step in initiating the designation process in your quest to provide HCBS in NY.

The Provider Designation Team will then review your application and assess your agency's readiness to provide services. This assessment will be based on the information provided in your application and any additional documentation you may have submitted.

Formal Designation Letter Issuance

Upon successful assessment of readiness, the Provider Designation Team will issue a Formal Designation Letter. This letter serves as official recognition of your agency's capability and readiness to provide HCBS in NY.

However, if the Provider Designation Team determines that your agency is not ready to provide services, you will be given a period of three months to prepare. After this period, a subsequent meeting will be held to reassess your readiness. If the team determines that your agency is still unprepared, your application will be closed.

The issuance of the Formal Designation Letter is a significant step in becoming a HCBS provider in NY. It is an assurance that your agency has met all the necessary requirements and is equipped to provide high-quality home and community-based services to those in need.

Maintenance of Compliance

Once you become an HCBS provider in NY, the work does not stop there. It's crucial to maintain compliance with all the tenets of the Final Rule and engage in ongoing monitoring to ensure your services continue to meet the necessary standards.

Ongoing Compliance Monitoring

The State Interagency Designation Team reviews newly designated HCBS providers through a rigorous process to ensure compliance with the Final Rule. Providers are requested to submit documentation verifying their compliance within six months of receiving their formal designation letter.

The Department of Health (DOH) will distribute an HCBS provider Final Rule self-assessment survey to all newly designated HCBS providers to assess compliance with the settings component of the Final Rule. The DOH may request further information based on the survey responses.

Following the compliance review, the DOH will continue to monitor providers' compliance with the Final Rule on an ongoing basis. This includes conducting the HCBS case record review process yearly, a vital part of ensuring the ongoing quality and compliance of the services being provided.

Attesting to Final Rule Standards

As part of the maintenance of compliance, providers are required to attest to compliance with Final Rule standards every three years during the Children's Waiver redesignation process.

Providers must compile required documentation into a zip file, complete a Documentation Worksheet, and submit these documents to ChildrensWaiverFinalRule@health.ny.gov within three weeks from the date of receipt. This process demonstrates the provider's compliance with the Final Rule and is an important part of maintaining their designation as an HCBS provider.

By keeping up with these requirements and regularly monitoring their compliance, HCBS providers can continue to offer valuable services to the children of New York. It's a responsibility that requires dedication and commitment, but it's also a role that can make a significant difference in the lives of many.