Overview of Services Available through the 1915(c) Consolidated Children's Waiver and 1915(c) Comprehensive OPWDD Waiver

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Overview of Services Available through the 1915(c) Consolidated Children's Waiver and 1915(c) Comprehensive OPWDD Waiver Note: Although the services may be defined and provided similarly, the provider for the services may be different. A participant can only be enrolled in one Waiver at any given time.
1915(c) Consolidated Children's Waiver		1915(c) Comprehensive OPWDD Waiver
Eligibility Criteria Age: Children and youth under 21 years old Medicaid: Must have Medicaid or be eligible for Medicaid Level of Care: Meet the Children's Waiver HCBS/Level of Care (LOC) Eligibility Determination criteria and be at risk for institutionalization Target Population The NYS Children's Waiver HCBS serves four main target populations: Serious Emotional Disturbance (SED) Medically Fragile (MedF) Developmental Disability (IDD) and Medically Fragile Developmental Disability (IDD) and in Foster Care Must reside in NYS		For individuals who have Intellectual and/or Developmental Disabilities (I/DD) of any age who are eligible for Office of Persons with Developmental Disabilities (OPWDD) services Eligibility Criteria Have a developmental disability as defined by New York State Mental Hygiene Law Section 1.03 (22) that originated before the age of 22; has continued or can be expected to continue indefinitely; and constitutes as a substantial handicap to such person’s ability to function normally in society Be in a Medicaid eligibility group that is eligible to enroll in Medicaid as described in the OPWDD HCBS Waiver and defined in SSA §§ 1634(c) and 1902(a)(10)(A)(i) and (ii) and 42 CFR Part 435 Need a Level of Care that would be provided in an Intermediate Care Facility for Individuals with Intellectual and/or Developmental Disabilities (ICF/IID) Reside in NYS and live in an appropriate living arrangement (and/or be residing in an appropriate living arrangement once enrolled in the HCBS waiver) as per OPWDD's waiver regulations Not be enrolled in another HCBS Waiver or Managed Long-Term Care (MLTC) Plan as described in 42 CFR §433 Subpart D; and Meet the requirement of a Reasonable Indication of Need for Services as defined in 42 CFR §441.302(c) and described in the OPWDD HCBS Waiver Target Population The OPWDD Waiver services individuals with an Intellectual Disability or Developmental Disability, or Both Must reside in NYS
Each participant enrolled in the Children's Waiver must receive care management through either a Health Home or Children and Youth Evaluation Service (C-YES). Health Homes provide the following Care Coordination Services:		Each participant enrolled in the OPWDD Waiver must receive care coordination through a Care Coordination Organization/Health Home (CCO)/HH provide the following Care Coordination Services:
Comprehensive Care Management - Assess needs, develop care plan Care Coordination and Health Promotion - Work with providers Comprehensive Transitional Care - Discharge planning, help to new programs Enrollee and Family Support - Assist with appointments and meetings Referral to Community and Social Supports - Link to Services and Resources, including Children's Waiver HCBS. *Children/families who opt-out of Health Home but remain enrolled in the Children's Waiver can receive care management through C-YES. C-YES offers a less intensive version of care management and only coordinates HCBS. C-YES does not assist with coordination of other supports/services outside of Children's HCBS.		Comprehensive Care Management - Assess needs, develop care plan Care Coordination and Health Promotion - Work with providers Comprehensive Transitional Care - Discharge planning, help to new programs Enrollee and Family Support - Assist with appointments, and meetings Referral to Community and Social Supports - Link to Services and Resources
Participants who meet eligibility criteria for the Consolidated Children's Waiver maybe able to receive the services below:		Participants who meet eligibility criteria** for OPWDD Comprehensive Waiver:
Community Habilitation Day Habilitation Prevocational Services Supported Employment Planned and Crisis Respite Adaptive and Assistive Technology (AAT) Environmental Modifications)(EMods) Vehicle Modifications (VMods) Caregiver/Family Advocacy and Support Services Non-Medical Transportation Palliative care - Expressive Therapy Palliative care – Pain and Symptom Management Palliative care – Counseling and Support Services Palliative care – Massage Therapy *Please see the Appendix for a description of these services		Community Habilitation Day Habilitation Prevocational Services - (Site-Based and Community-Based) Supported Employment (SEMP) Respite Assistive Technology - Adaptive Devices Environmental Modifications (Home Accessibility) Vehicle Modifications Residential Habilitation Community Transition Services Fiscal Intermediary (FI) Support Brokerage Individual Directed Goods and Services (IDGS) Live-in Caregiver Family Education and Training Intensive Behavioral Services *See Appendix for a description of these service* **per ADM 23-ADM-06: Pathway to Employment

APPENDIX Consolidated 1915(c) Children's Waiver Services (Available 4/1/2019)
Service	Description
Community Habilitation	Community Habilitation covers in-person services and supports related to the person's acquisition, maintenance and enhancement of skills necessary to independently perform Activities of Daily Living (ADLs), , Instrumental Activities of Daily Living (IADLs), and/or Health-Related Tasks, which may help a person accomplish specific tasks who has difficulties with skills related to: Self-care, Life safety, Medication and health management, Communication skills, Mobility, Community transportation skills, Community integration, Appropriate social behaviors, Problem solving, and Money management. Modality: Individual in-person service or Group in-person service
Day Habilitation	Day Habilitation provides assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, including communication, and travel that regularly takes place in a non-residential setting, separate from the person's private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy, and informed choice. Day Habilitation (DH) services must be provided to a child/youth at an OPWDD certified setting typically between the daytime hours of 9 a.m. and 3 p.m. Modality: Individual in-person service or Group in-person service
Prevocational Services	Prevocational Services are individually designed to prepare a youth (age 14 or older) to engage in paid work, volunteer work, or career exploration. Prevocational Services are not job-specific, but rather are geared toward facilitating success in any work environment for youth whose disabilities do not permit them access to other prevocational services. The service must be directed to teaching skills rather than explicit employment objectives. In addition, Prevocational Services assist with facilitating appropriate work habits, acceptable job behaviors, and learning job production requirements. Modality: This service may be delivered in a one-to-one session or in a group setting of two or three participants.
Supported Employment	Supported Employment services are individually designed to prepare youth with disabilities (age 14 or older) to engage in paid work. Supported Employment services provide assistance to participants with disabilities as they perform in a work setting. Supported Employment provides ongoing assistance to individuals with disabilities to help them obtain and maintain jobs in competitive or customized environments. This support aims for these individuals to earn at least minimum wage and receive equivalent wages and benefits as their non-disabled peers in similar roles. Modality: Individual in-person intervention
Respite	Respite focuses on short-term assistance provided to children/youth regardless of disability (developmental, physical, and/or behavioral) because of the absence of or need for relief of the child or the child's family caregiver. Such services can be provided in a planned mode or delivered in a crisis situation. Care involves offering supervision and activities tailored to the child or youth's developmental stage and goals, ensuring their health and safety are maintained.. Respite can not be used as a substitute for childcare. Modality: This service may be delivered in a one-to-one session or in a group setting of two or three participants
Adaptive and Assistive Technology (AAT)	Adaptive and Assistive Technology (AAT) provides technological aids and devices identified within the child/youth's POC which directly support an identified medical need and enable the accomplishment of daily living tasks that are necessary to support the health, welfare, and safety of the child/youth.
Environmental Modifications (EMods)	Environmental Modifications provide internal and external physical adaptations to the home or other eligible residences of the enrolled child which per the child's plan of care (POC) are identified as necessary to support the health, welfare and safety of the child or that enable the child to function with greater independence in the home and without which the child would require institutional and/or more restrictive living setting.
Vehicle Modifications (VMods)	Vehicle Modifications (VMods) provide physical adaptations to the primary vehicle of the enrolled child/youth which, per the child/youth's POC, are identified as medically necessary and provided as a goal in the child's POC to support the health, welfare, and safety of the child/youth or that enable the child/youth to function with greater independence
Caregiver/Family Advocacy and Support Services	Caregiver/Family Advocacy and Support Services enhance the child/youth's ability, regardless of disability (developmental, physical, and/or behavioral), to function as part of a caregiver/family unit and enhance the caregiver/family's ability to care for the child/youth in the home and/or community as well as, provides the child/youth, family, caregivers, and collateral contacts (family members, caregivers, and other stakeholders identified on the child/youth's POC) with techniques and information not generally available so that they can better respond to the needs of the participant. These services are intended to assist the child/youth, family/caregiver, and collateral contacts in understanding and addressing the participant's needs related to their disability(ies). Modality: Individual in-person intervention or Group in-person intervention -(no more than three HCBS) eligible children/youth or 12 participants (children and collaterals) may attend a group activity at the same time.
Non-Medical Transportation	Non-Medical Transportation services are offered, in addition to any medical transportation furnished under the 42 CFR 440.17(a) in the State Plan. Non-medical Transportation services are available for individuals to access authorized HCBS and destinations that are related to a goal included on the child/youth's Plan of Care.
Palliative care - Expressive Therapy	Palliative Expressive therapy helps children/youth to feel empowered in their own creativity, control, and aid in their communication of their feelings when their life and body may be rapidly changing during the stressful time of undergoing a chronic condition and/or illness and the trauma that often comes with its treatment. Whether through music, art, and/or play therapy, the child/youth may find an outlet that allows them to express their emotions safely and have a medium where they have complete control to play and explore with abandon. The family can participate as well, whether in the form of memories shared together or by tangible objects made by the child/youth they can hold onto - scrapbooks, paintings, or sculpture - mementos that tell their child/youth's life from their perspective and aid in their family's own journey of grief and loss. Modality: Individual in-person intervention.
Palliative care – Pain and Symptom Management	Palliative care is specialized medical care focused on providing relief from the symptoms and stress of a chronic condition or illness. The goal is to improve quality of life for both the child and the family. Palliative care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a child's doctors to provide an extra layer of support. It is appropriate at any stage of a chronic condition or illness and can be provided along with curative treatment. Pain and Symptom management involves relief and/or control of the child/youth's suffering related to their chronic medical, physical, or developmental condition Modality: Individual in-person intervention.
Palliative care - Massage Therapy	Massage Therapy is provided to improve muscle tone, circulation, range of motion, and address physical symptoms related to illness as well as provide physical and emotional comfort, pain management, and restore the idea of healthy touch for children/youth who are dealing with treatments that may involve painful interventions and ongoing and/or past trauma. Modality: Individual in-person modality
Palliative Care - Counseling and Support Services	Palliative Care is specialized medical care focused on providing relief from the symptoms and stress of a chronic condition or illness. The goal of Palliative Care services is to improve quality of life for both the child/youth and the family. Palliative Care is provided by a specially trained team of doctors, nurses, social workers, and other specialists who work together with a child/youth's doctors to provide an extra layer of support. It is appropriate at any stage of a chronic condition or illness and can be provided along with curative treatment. Modality: Individual in-person intervention; family eligible to participate

APPENDIX OPWDD Comprehensive Waiver Services
Service	Description
Residential Habilitation	Individually tailored supports that assist with the acquisition, retention or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living (hands-on), community inclusion and relationship building, training and support for independence in travel, transportation, adult educational supports, social skills, leisure skills, self-advocacy and informed choice skills, and appropriate behavior development that assists the participant to reside in the most integrated setting appropriate to his/her needs. Residential Habilitation services are limited to individuals who reside in OPWDD certified residential settings.
Community Habilitation	Services occurring largely in community (non-certified) settings to facilitate and promote independence and community integration. Community habilitation is defined as a face-to-face service and offers skills training and supports including adaptive skill development, assistance with activities of daily living, travel, health, adult educational supports, communication, social skills, leisure skills, money management, socially appropriate behaviors, life safety, self-advocacy, informed choice, community inclusion, and relationship building
Day Habilitation	Day Habilitation services include assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, including communication, travel, and adult education that regularly takes place in a non-residential setting, separate from the person's private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy, and informed choice. Day habilitation services may also be used to provide supportive retirement activities, including: altering schedules to allow for more rest time throughout the day, support to participate in hobbies, clubs and/or other senior related activities in their communities. A supplemental version of Day Habilitation is available for individuals who do not reside in a certified 24/7 location, including services occurring at night and on the weekend. OPWDD Day Habilitation can be provided on-site or "without walls" in the community.
Pathway to Employment	A person-centered, comprehensive career planning and support service that provides assistance for individuals to obtain, maintain, or advance in competitive employment or self-employment. It is a focused, time-limited service that engages a participant in identifying a career direction, provides instruction and training in pre-employment skills, and develops a plan for achieving competitive, integrated employment at or above the state minimum wage. Within 12 months or sooner, the outcome of this service is documentation of the individual's stated career objective; a detailed career plan used to guide individual employment supports; and preparation for supported employment services that assist an individual in obtaining, maintaining, or advancing in competitive employment or self- employment.
Prevocational Services (Site-Based and Community)	Services that provide learning and work experiences, including volunteering, where participants can develop general, non-job task specific strengths and skills that contribute to employability in paid employment in integrated community settings and increase levels of independence. Services are expected to occur over a defined period of time based upon a person-centered planning process. Services include activities that are not primarily directed at teaching skills to perform a particular job, but at underlying habilitative goals (e.g., attention span, motor skills, interpersonal relations with co-workers and supervisors) that are associated with building skills necessary to perform work and optimally to perform competitive, integrated employment. There are two separate types of prevocational services: Site-Based Prevocational Services and Community Prevocational Services. Site-based prevocational services are delivered in OPWDD certified non-residential facilities. Community prevocational services are provided primarily in community settings.
Supported Employment (SEMP)	Ongoing support to participants who need continuous support to obtain and maintain a job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce for which an individual is compensated at or above the state minimum wage. The outcome of this service is paid employment at or above the state minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals; as such, career planning is also an allowable service activity. Supported employment services may include any combination of the following services: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching, benefits support, training and planning, transportation, asset development and career advancement services, and other workplace support services including services not specifically related to job skill training that enable the individual to be successful in integrating into the job setting.
Respite	Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant. Respite care is not furnished or provided for the purpose of compensating relief or substitute staff in certified community residences.
Assistive Technology - Adaptive Devices	An item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants. These services directly assist a participant in the selection, acquisition, or use of an assistive technology device. The devices and services must be documented in the individual's Life Plan as being essential to their habilitation, ability to function, or safety, and essential to avoid or delay institutionalization. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Home-Enabling Supports (HES) is a sub-service added to Assistive Technology-Adaptive Devices service effective 10/1/23. Home-Enabling Supports are alternative services, equipment, or supplies which improve and maintain the individual's opportunities for full membership in the community. HES funds items and services that decrease the need for other Medicaid services, promote inclusion in the community, and/or increase the individual's safety and independence in the home environment. Examples of HES may be smart home devices, remote monitoring for the purposes of health and safety, or medical triage services.
Intensive Behavioral Services	Intensive behavioral services are short-term, outcome-oriented, and of higher intensity than other behavioral interventions and are focused on developing effective behavioral management strategies to ensure health and safety and/or improve quality of life. Available under the following circumstances: For individuals who reside in a non-certified residential location, their own home or family home, or a family care home; and The individual or a party acting on behalf of the individual certifies through written documentation that the individual is at risk of imminent placement in a more restrictive living environment due to challenging behavioral episodes.
Environmental Modifications (Home Accessibility)	Physical adaptations to the individual's home, required by the individual's Life Plan, that are necessary to ensure the health, welfare and safety of the individual, or that enable the individual to function with greater independence in the home, and without which the person would require institutionalization and/or more restrictive and expensive living arrangement. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Some modifications may include installation of ramps, hand rails and grab-bars, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies needed for the welfare of the recipient, lifts and related equipment, modifications of the kitchen necessary for the individual to function more independently in his home, strobe light smoke detection and alarm devices.
Vehicle Modifications	Physical adaptations to the individual's primary vehicle, required by the individual's Life Plan, that are necessary to ensure the health, welfare, and safety of the individual or that enable the individual to function with greater independence. These physical adaptations may include portable electric/hydraulic and manual lifts, ramps, and ancillary equipment or modifications necessary to guarantee full access to, and safety in, a motor vehicle.
Family Education and Training	Training given to families of individuals enrolled in the HCBS waiver is intended to enhance the decision-making capacity of the family unit, provide orientation regarding the nature and impact of an intellectual or developmental disability on the individual and their family, including behavioral management practices, and teach the family about service alternatives. The purpose is to support the family unit in understanding and coping with the intellectual or developmental disability and create a supportive environment at home to decrease premature residential placement outside the home.
Community Transition Services	Non-recurring set-up expenses for individuals who are transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence in the community, where the person is directly responsible for his or her own living expenses. Allowable expenses are those reasonable and necessary to enable a person to establish a basic household. Allowable items include security deposits that are required to obtain a lease on an apartment or home, essential household furnishings, set-up fees or deposits for utility or service access, and moving expenses.
Live-in Caregiver	An unrelated care provider who resides in the same household as the individual and provides supports to address the individual's physical, social or emotional needs in order for them to live safely and successfully in their own home. The Live-in Caregiver must be unrelated to the individual by blood or marriage.
Fiscal Intermediary (FI)	The fiscal intermediary supports the individual self-directing their HCBS services with billing and payment of approved goods and services, fiscal accounting and reporting, ensuring Medicaid and corporate compliance, and general administrative supports.
Individual Directed Goods and Services (IDGS)	Services, equipment, or supplies not otherwise provided through this waiver or through the Medicaid State Plan that addresses an identified need in an individual's Life Plan, which includes improving and maintaining the individual's opportunities for full membership in the community. Individuals who choose to self-direct their services with budget authority may receive IDGS as a waiver service. Individuals may manage their IDGS budget, as described in their Life Plan, to fully purchase or put funds towards their personal fiscal resources to purchase items or services which meet the criteria as described in the waiver.
Support Brokerage	Assist individuals (or the individual's family or representative as appropriate) to self-direct and manage some or all of their waiver services. The support broker assists the individual in the day-to- day management of services and provides support and training to the individuals and their family regarding the ongoing decisions and tasks associated with self-direction.