HCBS LOC Reassessment Eligibility Extension Guidance
ARCHIVED 3.14.2024
- Guidance also available in Portable Document Format (PDF)
Home and Community Based Services (HCBS) Eligibility Determination Reassessment Extension Guidance
TO: Health Homes, Health Home Care Management Agencies, and Children and Youth Evaluation Services (C-YES)
DATE: July 31, 2023
The Uniform Assessment System (UAS)-NY 1.15 release occurred on June 15, 2023. In this release, the Home and Community Based Services (HCBS) assessment includes a new module named "Eligibility Extension". This module identifies members who are enrolled in the Children's Waiver without an up-to-date annual HCBS re-assessment. This module can only be populated by the New York State (NYS) Department of Health (DOH).
Reassessments Waived Due to the Public Health Emergency
DOH will enter all reassessments that were reported by Health Homes or C-YES as waived due to the PHE no later than August 11, 2023. Care Management Agencies/C-YES should review previous and current Waiver-enrolled members to confirm the members were either reassessed or that an approved extension is documented in the module. If there are still members whose annual reassessment was not completed or for whom a waiver is not entered in this module by August 11, 2023, the care manager must contact the lead Health Home or C-YES by August 21, 2023 with the information requested below. The HH/C-Yes must provide a list of members who were not reassessed or entered into the module to the DOH Capacity Management Shared Mailbox via HCS SFT capacitymanagement@health.ny.gov with the following details by August 31, 2023:
- Child's CIN
- Child's First Name
- Child Last Name
- Date original HCBS Reassessment was due
- New requested HCBS Reassessment due date
Requesting Extensions for Extenuating Circumstances
Effective January 2023, the requirement to conduct annual HCBS reassessments for all members is no longer waived, as outlined in guidance, "End of PHE Children's HCBS Level ofCare Eligibility Determination Flexibility". All members must be reassessed for continued Waiver eligibility annually.
Although care managers should start the reassessment process two months prior to the reassessment due date, there may be times when the reassessment cannot be accomplished timely due to extenuating circumstances such as hospitalization/institutionalization, or if the member is out of the state. Care managers may request an extension of up to 90 days to complete the annual reassessment. An approved extension allows for the member to remain enrolled in the Children's Waiver for up to 90 days. If a reassessment cannot be completed
within 90 days of the reassessment due date, the member must be disenrolled from the Children's Waiver. Extensions will not be granted for routine delays by the care manager completing the assessment.
To request an extension, a care manager must complete and submit an "HCBS Reassessment Eligibility Extension Request Form" (which can be found here under "CANS-NY/HCBS Level of Care Policy & Guidance Documents" section) to their Lead Health Home/C-YES at least 20 business days prior to the annual reassessment due date. On the form, the care manager will indicate the reason for the extension (Hospitalization/Institutionalization, Out of the State/Country, or Other: specify the reason for the extension request), the reassessment due date, and the requested new due date (e.g., Date Reassessment is due 7/1/2023, Requested New Due Date 9/1/2023).
The Lead Health Home/C-Yes must approve or deny the form and submit it to the NYS DOH Capacity Management Shared Mailbox in Secure File Transfer (SFT) to capacitymanagement@health.ny.gov within two business days of receipt from the care manager. If the extension request is approved by DOH, the new due date will be populated within the UAS "Eligibility Extension" module (UAS reference sheet guidance attached below).
Care managers must document the reason that the overdue reassessment could not be accomplished timely in the member's record.
Please utilize the UAS Reference Sheet below for more information and can also be located within the UAS read materials.
