Children's Consolidated Waiver Services (HCBS)

• Notification is also available in Portable Document Format (PDF)

Notification of Updated Children's Waiver Home and Community Based Services (HCBS) Rate Sheet for Services Provided in Designated Rural Counties

To: Medicaid Managed Care Plans (MMCPs), including Mainstream Managed Care Plans and HIV Special Needs Plans and Children's Waiver Home and Community Based Service (HCBS) providers

Date: November 27, 2023

Effective December 1, 2023, the New York State Department of Health (DOH) is establishing rural rates for Children's Waiver HCBS, per the Centers for Medicare and Medicaid Services (CMS) approval of Amendment NY.4125.R06.01. There are seven upstate counties where the rural rates are applicable: Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, and St. Lawrence. The rate codes and government rates that must be paid by Medicaid Managed Care Plans (MMCPs) are posted to the DOH website at the following link and will be loaded in eMedNY when final state approvals are in place:

Upon final state approvals and announcement that rates have been loaded in eMedNY, MMCPs must reconfigure their systems to pay the appropriate rates for HCBS provided in the identified rural counties. Providers should hold managed care claims for dates of service on or after December 1, 2023, until notified by the managed care plan that the system configuration is complete. Plans must extend the deadline for timely submission of these claims to no earlier than 90 days after the date the system configuration is complete, and providers are notified and given billing instructions.

All billing change requirements are effective for dates of service on or after December 1, 2023.
Updates to Billing Requirements for Children's HCBS, CFTSS, and 29-I OLHRS

Questions on HCBS rates can be submitted to BH.Transition@health.ny.gov.