Overview
Enrollment in a CCO/HH is dependent on eligibility. This section outlines the policies and procedures for Health Home enrollment only.
For information on eligibility requirements see Eligibility and Referrals
For enrollment in other Care Management services provided by CCO/HHs, refer to the below sections:
- Information on Basic HCBS Plan Support
- Information on Non-Medicaid Care Management
- Information regarding enrollment and disenrollment of Willowbrook Class Members
Notice of Determination (NOD) for Enrollment into the CCO/HH Program (DOH-5234)
Form DOH-5234 notifies the person and/or their family/representative of the individual’s CCO/HH enrollment and the commencement of Care Management services. The notice must be mailed to the person along with the CCO/HH welcome letter.
More information on NODs is located in Notice of Determination section.
OPWDD CHOICES
Enrollment into CCO/HH is tracked in OPWDD’s CHOICES system. CHOICES is OPWDD’s internal electronic repository containing program information for people receiving services from OPWDD service providers.
The CCO/HH is also required to use the CHOICES system to submit:
- Enrollments (CCO1)
- Disenrollments (CCO2)
- LCED
- DDP1
- DDP2
- Access to CAS/CANS summary document
- Service access information related to eligibility, authorizations, and necessary supporting documentation of its enrollees
CCO/HH’s may access current enrollments via CHOICES anytime and run individual or program enrollment inquires.
CCO/HH Enrollment Activities
| Activity | Timeframe from enrollment | Further Guidance/Information |
|---|---|---|
| Liability for Service Notice | During intake | Eligibility and Referral; OPWDD’s liability webpage. |
| CCO/HH Care Manger Checklist Completed | Within 30 days of enrollment | CCO Care Manager Checklist |
| Notice of the Person-Centered Planning Process and Life Plan | Prior to Person-Centered Planning Process and development of Life Plan | Person-Centered Planning and Life Plan |
| First In-Person Meeting | Within 60 days | Comprehensive Assessment |
| Comprehensive Assessment Process Completed | Within 60 days | Comprehensive Assessment |
| Initial Life Plan Completed | Within 90 days | Life Plan |
| Application for Participation in the OPWDD HCBS Waiver and Documentation of CHOICES form | As soon as possible as appropriate/needed. | OPWDD's HCBS Waiver Application webpage |
CCO/HH Checklist (Published)
Care Managers, or a designee of the Care Manager whose responsibility is to educate people and their families on CCO/HH services (i.e., CCO/HH Intake staff member), are required to complete the CCO/HH Care Manager Checklist.
The checklist assists with identifying and understanding the person/family’s current service needs and educates the person/family on CCO/HH services. This checklist must be completed:
- To initiate and bill for CCO/HH services;
- In partnership with the person and their family/designated representative;
- In-person face-to-face or via telephone or remotely;
- No later than thirty (30) days from CCO/HH enrollment.
Care Managers (or their designee) also have the option of completing the Checklist at the time the CCO/HH consent forms are reviewed and signed by the person/family.
This process is essential to the successful delivery of the Health Home core services and identifies any additional service needs of the person. People may change CCO/HHs at any time. A new Checklist will need to be completed within thirty (30) days of enrollment into a new CCO/HH.
Upon completion of each task, this Checklist must be signed and dated by the person who completed the tasks. Additionally, it is required that the Care Manager sign and date the checklist indicating whether they completed it independently or if it was completed by their designee. It is a best practice to have the signature of the person or their involved family member/designated representative, but it is not required.