HCBS Eligibility, Services, and Plan of Care (POC)
Policy
- HCBS Service Definition and Necessity Criteria Policy #CW0020 - (Web) - (PDF) - May 16, 2025
- Health Home Plan of Care Policy #HH0008 - (Web) - (PDF) - Updated December 2024
- Children's HCBS POC Workflow Policy #CW0002 - (PDF) - Updated May 2022
- Children's Home and Community Based Services (HCBS) Waiver Eligibility and Enrollment Policy #CW0005 - (Web) - (PDF) - March 2024
Guidance
- Clarification - Children's Waiver Home and Community Based Services (HCBS) Recipient Restriction/Exemption (R/RE) K-Codes for Eligibility and Enrollment - (Web) - (PDF) - March 28, 2025
- Update on Children's Waiver HCBS Referrals for Children/Youth Who Opt-Out of Health Home - (Web) - (PDF) - December 17, 2024
- Reminder: Children's Home and Community Based Services Medically Fragile and Serious Emotional Disturbance Target Population - (PDF) - December 6, 2024
- GIS 24 MA-04 - Medically Fragile or Developmentally Disabled and Medically Fragile Consumers enrolled in the 1915(c) Children's Waiver and County Single Point of Access (C-SPOA) role - (PDF) - June 3, 2024
- Medically Fragile Children's Waiver Eligibility Determination FAQ - (Web) - (PDF)
- SED Children's Waiver Eligibility FAQ - (Web) - (PDF)
- Extension of Deadline to Obtain Disability Determinations for Medically Fragile Children's Waiver Members - (Web) - (PDF) - October 31, 2023
- Children's HCBS Medicaid Managed Care Plan Transfer Continuity of Care Requirements - (Web) - (PDF) - September 5, 2023
- UPDATE: Changes to the Disability Documentation Process for the 1915c Children's Waiver - (PDF) - July 27, 2023
- Guidance Regarding the Medically Fragile Disability Determination Requirement - (Web) - (PDF) - April 2023
- Clarification Guidance Re: Children's Waiver HCBS Serious Emotional Disturbance (SED) Eligibility Determination Requirements - (Web) - (PDF) - April 2023
- Updated LPHA Guidance and Instructions - (Web) - (PDF) - July 29, 2022
- Children's HCBS Plan of Care (POC) Workflow Policy Reminder - (Web) - (PDF) - November 16, 2022
- Children's HCBS POC Workflow FAQ - (Web) - (PDF) - Updated May 2022
- Reminder Regarding Children's HCBS Billing and Claiming Requirements - (PDF) - April 4, 2022
- HCBS POC Workflow Policy Requirement Reminder - (PDF) - November 2020
- HCBS POC Workflow DESK AID, Roles and Responsibilities - (PDF) - October 2020
- REMINDER for HCBS PROVIDERS: Children's HCBS Authorization Form and Communication with MMCP - (PDF) - March 2020
- Medicaid Managed Care Plans' Contact Information - (PDF)
- Services Access Documentation - (PDF) - March 2019
- Person Centered Service Planning Guidelines - (PDF) - December 19, 2018
Webinars
- HCBS Service Definitions and Necessity Criteria Policy Pt.1 - (PDF)
- Children'S Waiver HCBS Fee-For-Service Authorization Webinar - (PDF) | (Recording) (YouTube) - January 24, 2025
- HCBS Service Referral Process & Expectations - (PDF) | (Recording) (YouTube) - October 2024
- Considerations for Determining HCBS Eligibility for the Serious Emotional Disturbance (SED) Target Population - (Web) - (PDF) - (Recording) - April 19, 2023
- Updates and Clarification Regarding:
- Medically Fragile (MF) Population HCBS LOC Determination: - (Web) - (PDF) - (Recording) - April 6, 2023
- Serious Emotional Disturbance (SED) Target Population HCBS LOC Eligibility Determination - (Web) - (PDF) - (Recording) - April 4, 2023
- Health & Safety Planning Requirements for the Children's Waiver webinar slides - (PDF) | Recording (YouTube) - September 2021
- Children's HCBS Planning and Plan of Care Development - (external link) - April 3, 2019
- Webinar and Discussion with HCBS Providers regarding HCBS POC Workflow - (PDF) - October 2020
- Webinar: Children's HCBS POC Workflow & MMCP Service Authorization for HCBS Providers - (PDF) - October 18, 2019
- Children's HCBS POC Workflow Webinar - (PDF) | Recording (YouTube) - August 28, 2019
Resources
Forms
HCBS LPHA Attestation Forms
Freedom of Choice Form
DOH-5276 - Freedom of Choice - Effective October 2024
Medically Fragile Target Population Forms
- Disability Review Team Certificate - DOH 5144 (PDF)
- Childhood Medical Disability Report - DOH-5151 (PDF)
- Questionnaire of School Performance - DOH-5152 (PDF)
- Description of Child's Activities - DOH-5153 (PDF)
- Disability Questionnaire - DOH-5139 (PDF)
- Authorization for Release of Health Information Pursuant to HIPAA - DOH 5173 (PDF)
Notice of Decision Forms
Form DOH-5287
DOH-5287 Notice of Decision For Enrollment or Denial of Enrollment in the New York State 1915(c) Children's Waiver - Updated October 2024
- English (DOH #5287) (PDF)
Form DOH-5288
DOH-5288 Notice of Decision For Discontinuance in the New York State 1915(c) Children's Waiver - Updated October 2024