Home and Community Based Services Waiver

Overview

Comprehensive Home and Community-Based Services (1915-c HCBS) Waiver
The Home and Community Based Services Waiver is the Medicaid program that provides opportunities for adults and children with intellectual and developmental disabilities to receive services in their own home or community.

Current Waiver

Appendix K

An Appendix K is an appendix to the Home and Community-Based Services Waiver agreement between OPWDD and the federal Centers for Medicaid & Medicare Services (CMS). Appendix Ks are used during emergency situations in which typical standing waiver provisions must be suspended or altered to support service delivery during the period of the emergency. During the COVID-19 pandemic, OPWDD applied for and received federal approval for an Appendix K and subsequent revisions to that appendix.

COVID-19 Appendix K Documents

Day Services Retainer & Site Based Flexibilities

Last Eligible Day for Claiming through the Day Services Retainer Program is July 21, 2020

Providers that have opted to participate in the OPWDD Day Service Retainer Program Please note: this guidance does not address retainer payments for Community Habilitation services delivered by ‘self-hired’ staff and paid by Fiscal Intermediary agencies as part of a person’s self-directed budget.

Based on recent federal guidance in which CMS limited the number of retainer days that providers are allowed to bill, the last service date for submitting retainer day claims to eMedNY under the Day Service Retainer Program is July 21, 2020.

This program was announced in a memorandum from DOH Deputy Director Donna Cater, dated 06/05/20, and provided retainer payments to agencies that signed an attestation, agreeing to the program’s rules of participation. We fully understand that agencies did not anticipate this end-date for the program. OPWDD and our state agency partners are examining options to address the ability of agencies to continue to support individuals and families.

Please note the following:

  • If your agency has signed and submitted to OPWDD the Day Service Retainer Day program Attestation, then you may continue to submit retainer day claims (using revenue code 0180) to eMedNY for service dates of April 18, 2020 through July 21, 2020. Retainer day claims are subject to the requirements of the Day Service Retainer program and guidance.
  • This guidance does not affect the ability of Supervised Individualized Residential Alternative Agencies (IRAs) to deliver and bill eMedNY for Group Community Habilitation-Residential (Group CH-R)for individuals who live in the Supervised IRA and participated in another agency’s Day Habilitation or Prevocational Services. The authorized provision of Group CH-R services continues to be eligible for claiming to eMedNY.
  • Agencies that participate in the Day Service Retainer Program may continue to deliver and bill Medicaid for alternate services as documented in the person’s Life Plan. For example, delivering Community Habilitation to individuals who live with their family and participated in your agency’s Day Habilitation program prior to the onset of COVID-19.
  • Agencies continue to have the flexibility to deliver remote services per
    guidance available on the coronavirus guidance webpage.

Please direct any questions and concerns to [email protected]
 

Supplemental Payments for ICF/IID Providers

OPWDD conducted a webinar on May 28, 2021 to assist in understanding recent billing guidance issued to OPWDD agencies operating Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) in response to the COVID-19 pandemic and the recent approval of the emergency State Plan Amendment (SPA).