Home- and community-based services for Health and Recovery Plan beneficiaries

Home- and community-based services (HCBS) provide opportunities for Health and Recovery Plan (HARP) beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

 

This service can be accessed after the case management agency completes the eligibility assessment. A determination is then made as to whether the member is considered within tier one, tier two or not eligible for HCBS. Respite services do not require an eligibility assessment or a plan of care (POC) to be completed. Respite providers may contact the health plan directly for authorization of services.

Tier 1 -
Short-term crisis respite - no assessment of POC needed
Prevocational
Transitional employment
Intensive supported employment
Ongoing supported employment
Education support services
Peer

Tier 2 -
Psychosocial rehabilitation

Not Eligible - 
Community psychiatric support and treatment
Habilitation supports services
Family support skills training

Level of service determination (LOSD) letters

An LOSD letter request may be written or verbal and, at a minimum, should include the following information:

1. All services the individual is receiving
2. Tier eligibility
3. Person-centered goals
4. Recommended (HCBS) service
5. Housing setting

 

Submission information

A LOSD request, single POC or finalized POC, can be sent via email or fax:

Email: NYHARP@empireblue.com

Fax: 1-844-528-3686

 

State Designated Entities

The State has established processes and protocols for managed care organizations to partner with state-designated entities to assist in efforts to ensure HARP members who are not currently enrolled in Health Homes are given the opportunity to access HCBS.

 

State-designated entities will conduct the NYS Eligibility Assessment for adult behavioral health (BH) HCBS. State-designated entities will use the NYS Eligibility Assessment to determine a HARP member’s eligibility for BH HCBS (tier 1, tier 2, or not eligible for HCBS).

 

Once determined the member is eligible for, and wishes to access HCBS, a request will be made for an LOSD. The state-designated entity will offer the member a choice of HCBS providers, make referrals to the appropriate HCBS providers, and develop and maintain the HCBS POC.

 

For more information

To speak with either an HCBS or a state-designated entity representative, please contact:

• Indira Green: 347-346-2984
• Merlann Haigler: 347-920-7939
• Member Services: 1-800-300-8181