GIS 17 MA/010: Approval of 1915(c) Home and Community Based Services Care at Home(CAH) I/II Waiver Program Process and Enrollment

The purpose of this GIS is to advise the Local Department of Social Services (LDSS) staff of the enrollment process and eligibility determination procedures for the Care at Home (CAH) I/II waiver program. The eligibility date for participation into the CAH I/II waiver program is the date upon which financial eligibility, programmatic eligibility, and a plan of care are completed and approved by the LDSS. The CAH I/ II waiver application cannot be processed until a complete, fully documented, signed and dated application is submitted to the LDSS. Therefore, the applicant cannot be found eligible for the waiver prior to the date of that submission to the LDSS. This date is noted on the CAH I/ II Program Application Cover Sheet by the LDSS as the "Date Application is received by the LDSS." Once the LDSS reviews the completed application and recommends enrollment in the waiver, the LDSS enters the recommended date for eligibility on the Application Cover Sheet as the "Date the LDSS is recommending for waiver eligibility". This date may be the same as the "Date Application is received by the LDSS," but may not pre-date it. Paid or unpaid medical bills for the three-month period prior to the month of the complete application may be eligible for Medicaid payment. The three-month retroactive period begins on the first day of the month the LDSS receives the complete, fully documented, signed and dated application. For example: If the complete application is received on April 30th, the three-month retroactive period is the period between January 1st through March 31st. The CAH I/II eligibility date will be January 1.

Care at Home I/II case management services will not be reimbursed if the child is receiving case management through Early Intervention (EI) Service Coordination or Medicaid Service Coordination (MSC). Therefore, this date is noted by the LDSS on the CAH I/II Program Application Cover Sheet as "Early Intervention Service Coordination or Medicaid Service Coordination end date." The recommended date for waiver eligibility established by the LDSS, may not pre-date the end date of EI or MSC services.

For the Department of Health (DOH) to process a CAH I/II waiver application after LDSS review, the application must include the following:

• CAH I/II Application Cover Sheet
• Proof of Medicaid (MA) Eligibility
• If MA eligible based on parental income/resources, then the child's MA number/client identification number (CIN#) will suffice
• If MA ineligible when parental income/resources is counted, the scratchpad budget is required, showing the child is MA eligible when parental income/resources is not counted. Also, please provide the Notice of Decision.

• Home Assessment Abstract - must be current
• Uniform Assessment System-NY Pediatric 0-3 or Pediatric 4-17 The UAS-NY is to be completed within 90 days of waiver eligibility or the completed Pediatric Patient Review Instrument (PPRI) if unable to complete UAS-NY in a timely manner.
• Pediatric Patient Review Instrument -If child resides in Skilled Nursing Facility or Hospital or if unable to complete UAS-NY in a timely manner
• Child’s Birth Certificate
• Documentation of Disability (SSI letter or DSS-639)
• Physician orders – must be complete and must be renewed every 60 days
• Monthly Budget Sheet
• Case Management Plan of Services
• Choice of Care
• Application Form signed and dated by parent/guardian

Please be advised if the CAH I/ II waiver application is not complete or current, the application will be returned to the LDSS. The LDSS will be instructed to return the application to the case management agency for completion. At the point in time when the completed application is resubmitted to the LDSS, the LDSS will complete a new CAH I /II Program Application Cover Sheet. The Application Cover Sheet must reflect the date the complete application was received by the LDSS. A new recommended date for waiver eligibility will be provided by the LDSS upon their review and approval of the application.

The Medicaid Waiver Care at Home I/II Program Application Cover Sheet is revised effective May 2017 to include the following changes:

• Early Intervention or Medicaid Service Coordination end date.
• Pediatric Patient Review Instrument - may be completed; however, the UAS-NY must be completed within 90 days of waiver eligibility or the completed PPRI.
• Removed Pain and Symptom Management: no longer a waiver service.

As described in GIS 16 MA/01, the CAH I/II waiver program has initiated an electronic process for CAH I/II waiver applications. Please submit requests for CAH I/II applications via email at cah@health.ny.gov. or via fax at (518) 473-2537. If not capable of submitting via email or fax, applications will be accepted by mail. If you require any assistance regarding CAH I/II operations, please contact Linda Milano, CAH Coordinator, at 518-473-6020.