Benefit Development Resource Toolkit: Liability for Services

Liability for Services Regulations

OPWDD regulations require individuals with developmental disabilities who wish to receive specific Medicaid funded OPWDD service(s) to apply and be approved for Full Medicaid Coverage. Full Medicaid Coverage is defined as the type of Medicaid coverage that pays for the services being requested or received. Additionally, if an individual wants to receive an OPWDD HCBS Waiver service, the individual must take all necessary steps to enroll in the HCBS Waiver. If services other than those provided through the HCBS Waiver are being requested, eligibility requirements may differ. For example, individuals requesting placement in a Voluntary Operated Intermediate Care Facility (VOICF) will require an ICF Level of Care Eligibility Determination (LCED).

The regulations impose different requirements depending on whether a service is ‘other than preexisting’ or ‘preexisting’. Other than preexisting services are those that started on or after the date the regulations went into effect for the service. Preexisting services are those that an individual was receiving on a regular basis at the time the regulations were implemented for the services.  The implementation dates were:

  • February 15, 2009 for ICF/IDD facilities; Residential Habilitation delivered in IRAs, CRs, and Family Care; and Day Habilitation 
  • March 15, 2010 for Care Management, Day Treatment Services, Community Habilitation, Prevocational Services, Supported Employment Services, and Respite Services

Care Management was formerly titled “Medicaid Service Coordination”. This includes “Other Service Coordination” also referred to as mirrored MSC, state paid/funded MSC, non-Medicaid, or case management.

In the future, as new services are implemented within the OPWDD delivery system, they may also be subject to liability regulations.

You can access the full text of the regulations at: https://govt.westlaw.com/nycrr/Browse/Home/NewYork/NewYorkCodesRulesandRegulations?guid=I598fe980260111dea8a8bdde472ef003&originationContext=documenttoc&transitionType=Default&contextData=(sc.Default)
Additional information related to the Liability for Services regulations is available at:
https://opwdd.ny.gov/providers/liability

Responsibilities

The liability regulations outline specific responsibilities for service providers, individuals requesting or receiving services, their representatives, care managers, OPWDD’s Developmental Disabilities Regional Offices (DDROs), Revenue Support Field Offices (RSFOs), and Central Operations unit. These responsibilities are outlined in the Liability for Services Quick Reference Guide at:
https://opwdd.ny.gov/system/files/documents/2020/10/liability-for-services-regulations-quick-reference-guide.pdf.

Service providers are required to issue liability notices to individuals requesting or receiving services and any liable parties. The liability notices are available at:
https://opwdd.ny.gov/notice-persons-applying-services.    

Individuals who wish to receive services but do not wish to apply for Medicaid and/or HCBS Waiver must arrange to pay the service provider directly. Service providers are not obligated to begin serving individuals who refuse to apply for benefits or fail to disclose financial information necessary to determine their ability to pay.

Limited Exception for Respite Services

Individuals who are requesting or receiving respite services, and no other services covered by the liability regulations, are qualified for a limited exception.  The limited exception means you can receive respite services without being billed for the service and without applying for Medicaid and the HCBS Waiver.  If an individual’s respite services were Medicaid funded any time on or after March 15, 2010, they do not qualify for the limited exception.  Additional information can be found in the Quick Reference Guide at:

https://opwdd.ny.gov/system/files/documents/2020/10/liability-for-services-regulations-quick-reference-guide.pdf  

and in notice OPWDD LIAB 10 – Information about the Limited Exception for Respite at:  https://opwdd.ny.gov/information-about-limited-exception-respite.

Additional Resources

Individuals interested in receiving OPWDD services must be determined eligible.  The first step is to contact OPWDD’s Front Door.

OPWDD’s DDROs assist individuals and service providers with HCBS Waiver enrollment.  Assistance with HCBS Waiver enrollment can be obtained through the Front Door.

OPWDD's local Revenue Support Field Offices (RSFOs) are available to assist service providers, individuals seeking services, and their families and advocates as they work to establish eligibility for Medicaid and other benefits.