Breaking: OMH Broadens Authorization to Link Individuals to Home and Community Based Services Beyond Health Homes!

NYAPRS Note: Heretofore, Health and Recovery Plan members have been able access to recovery based Home and Community Based Services ONLY if they were enrolled in a health home that administered the requisite eligibility assessment and developed a person centered plan of care.

OMH has just released guidance extending that authorization to qualified assessors in other ‘state designated entities’. See below for the definition of what a single designated entities.

This is a major advance in opening up access to HCBS to a much broader group of individuals! Stay tuned for more details.    

Attached is the OMH/DOH/OASAS issued guidance sent to Managed Care Plans, HARPs and HIVSNPs, advising them to contract with community providers to assist HARP members in accessing Home and Community Based Services (HCBS) who are not enrolled or do not wish to be enrolled in a Health Home. These providers are defined as a “state designated entities (SDE)” and would establish direct contracts with the MCO to do Eligibility Assessments and Person-Centered care planning for Adult Behavioral Health HCBS.

Who is the SDE?

Although the agencies identified must have a care management program within that agency, the Adult BH HCBS assessment and care planning work is not limited to the care management program, but may also include qualified assessors in various parts of the agency including housing and clinical programs. It is the intention of the State to offer HARP members the opportunity to understand their benefit package including the new HCBS, and be assessed for eligibility by an individual they may already have a working relationship with when possible. As outlined in the guidance, the assessor must follow existing conflict free case management standards, and work with the individual to link them to Adult BH HBCS. 

How can the SDE help connect the HARP enrollee I am working with to HCBS?

If you are not a provider of health home care management services but are working with HARP enrollees who are not linked to a health home, you may contact the individual’s MCO to learn more about how to connect the individual to health home care management or directly to a State Designated Entity for access to HCBS.

A webinar will be held in the near future to provide further information. Please contact the HCBS mailbox for any questions regarding the State Designated Entity for Adult BH HCBS.  

Final SDE Guidance PDF