GIS 12 MA/031: Consolidation of Care at Home (CAH) III, IV and VI model waivers into a new 1915(c) waiver known as the OPWDD Care at Home Waiver
To: Local District Commissioners, Medicaid Directors
From: Jason A. Helgerson, Medicaid Director - Office of Health Insurance Programs
Subject: Consolidation of Care at Home (CAH) III, IV and VI model waivers into a new 1915(c) waiver known as the OPWDD Care at Home Waiver
Effective Date: April 1, 2013 (target date pending federal approval)
Contact Person: Medicaid Fee-For-Service Policy Liaison: (518)473-2160, OPWDD Contact – Lynda Baum-Jakubiak: (518)474-5647
The Office for People with Developmental Disabilities (OPWDD) and the Department of Health (DOH) are working with the Centers for Medicare & Medicaid Services (CMS) to combine CAH III, IV and VI into a single 1915(c) waiver program. The new waiver will be known as the OPWDD Care At Home Waiver, and will become effective on April 1, 2013. The purpose of this consolidation is to streamline and strengthen New York State's administrative oversight and reporting mechanism for these waiver programs.
Effective April 1, 2013, case management services with a date of service on or after April 1, 2013, must be billed utilizing rate code 2311 (Case Management Care At Home - IV ) for all children receiving OPWDD CAH case management services, regardless of which waiver the child was enrolled in prior to April 1, 2013. Billing submitted for case management services under the CAH III or CAH VI waiver rate codes (2305 and 2317 respectively) for services provided on or after April 1, 2013 will be denied. Rate code 2311 has been utilized as the single, statewide rate code for Care at Home IV since October 1, 2007 and will be used for all eligible individuals enrolled in the consolidated CAH Waiver.
In addition, beginning on April 1, 2013, there will be one recipient Restriction/Exception Code (R/E code) used for all children receiving OPWDD CAH services. The R/E code to be used is 65, which is the current R/E code for CAH IV. R/E Codes 64 (CAH III) and 67 (CAH VI) will no longer be valid. R/E Codes for children enrolled in CAH III and VI on April 1, 2013 will be automatically changed to R/E Code 65.
Children who are currently served under CAH III, CAH IV and CAH VI who have coverage on April 1, 2013 will be automatically enrolled in the new waiver. There should be no disruption in services and the transition should be transparent to the individuals receiving services and their families.
Billing for Environmental Modifications/Assistive Technology and Respite services under the OPWDD Care at Home Waiver will continue to be submitted directly to OPWDD through the voucher claiming process.
Families of children enrolled in CAH III, IV and VI, and agencies providing case management services to these children have been notified in writing of this administrative change and waiver consolidation.
