GIS 17 MA/009: Approval of 1915(c) Home and Community Based Services Care at Home(CAH) I/II Waiver Program and Application

The purpose of this GIS is to inform the Local Department of Social Services (LDSS) staff that the request to renew the Care at Home (CAH) I/II Waiver Program has been approved by CMS effective April 01, 2017. The approved application includes language indicating that the waiver will transition into managed care via the 1115 authority on January 1, 2018. This waiver provides services to children 0-17 years old, who have physical disabilities and require either a skilled nursing facility or hospital level of care. The waiver will continue to serve children living at home with parents or legal guardians.

The waiver services authorized in this approval are: Case Management, Bereavement Services, Expressive Therapies, Massage Therapy, Home and Vehicle Modifications and Family Palliative Care Education (Training). Pain and Symptom Management and Respite Services are removed as services from the CAH I/II waiver program.

The Uniform Assessment System (UAS-NY) is to be implemented within sixty (60) days of waiver approval and will replace the currently used Pediatric Patient Review Instrument (PPRI) to evaluate the level of care (LOC) (skilled nursing facility or hospital level of care) for Care at Home I/II eligibility and annual reassessment. Children placed in a hospital and/or skilled nursing facility settings will continue to be assessed using the Pediatric Patient Review Instrument (PPRI), and the UAS-NY will be completed within ninety (90) days of waiver eligibility or the completed PPRI. The level of care re-assessment is now required annually.

All Case Management services will continue to be reimbursed using the existing rates and 15-minute unit fee schedule. CAH I/ II waiver program will implement a caseload size limit effective October 1, 2017, establishing a maximum caseload size of no more than thirty (30) individuals per case manager. This caseload limit is inclusive of any individual that the case manager renders Case Management services to, and is not limited to those individuals receiving services under the CAH I/II waiver. Case Management services are limited to one hundred twenty (120) hours annually, not to exceed ten (10) hours monthly, unless otherwise indicated in the participant’s plan of care and authorized by the LDSS. All waiver participants must have a monthly face-to-face visit with their case manager.

Other changes in services are as follows:

• Family Palliative Care Education (Training) services may not exceed five (5) hours per day, eight (8) hours monthly and one hundred (100) hours annually and must be identified in the participant’s plan of care. Additionally, a Medical Social Worker providing the service must be licensed in the State of New York.
• Bereavement Services may not exceed five (5) hours daily; one hundred twenty (120) hours annually and must be identified in the participant’s plan of care.
• Massage Therapy services may not exceed one (1) hour per week; not to exceed five (5) hours per month and must be identified in the participant’s plan of care.
• Expressive Therapies may not exceed one (1) hour per week; not to exceed five (5) hours per month and must be identified in the participant’s plan of care.
• The maximum expenditure for home and vehicle modifications may not exceed $25,000 for home and $25,000 for vehicle modifications per five (5) year period and must be identified in the participant’s plan of care.

In the future, the CAH I/II Waiver Program will require cost reporting and proper billing and utilization data from waiver providers. The collection of this data, in some cases, will be used to support retrospective reimbursement with an annual reconciliation; and/or require use of this data to support renewals, waiver amendments, or transition 1915(c) waiver services to 1115 waiver or State Plan services.

If you require any assistance regarding CAH I/II operations, please contact Linda Milano, CAH Coordinator, at 518-473-6020, or via email at cah@health.ny.gov.