Children's Waiver Home and Community Based Service (HCBS) Contracting Requirements for Medicaid Managed Care Plans (MMCPs)

February 4, 2025

• Guidance also available in Portable Document Format (PDF)

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

Medicaid Managed Care Plans (MMCPs) are responsible for maintaining adequate networks to support timely connection to and provision of Children's Waiver HCBS to eligible members. As outlined in the New York State Children's Health and Behavioral Health Benefit Administration Children's System Transformation Requirements and Standards.

MMCPs must extend offers to and establish contracts with at least 50% of designated HCBS providers in each county that the MMCP operates, unless there are only two providers in a given county. If there are only two designated providers in a county, the MMCP operating in that county must contract with both designated providers. In areas where these minimum network standards are not adequate to meet the MMCP's members' need for access and/or to meet appointment access standards, the MMCP shall be required to exceed the minimum network standards.

MMCPs must have a process for regularly monitoring their contracted network's adequacy and developing strategies to ensure uninterrupted services to members. MMCPs should use the resources available to them including the Exhibit 4 and referral data available in the Children's Waiver Referral and Authorization Portal within the Incident Reporting and Management System (IRAMS).

Questions on how to locate or navigate these resources can be sent to BH.Transition@health.ny.gov.