Transition Plan - New York State Department of Health

1
Overview
On January 16, 2014, the Center for Medicare and Medicaid Services (CMS) published the final rule
related to Home and Community Based Settings (HBCS) for Medicaid-funded long term services and
supports provided in non-institutional residential settings under the following authorities of the Social
Services Act: 1915(c), 1915(i) and 1915(k). This rule implements a number of changes to home and
community based waivers, finalizes regulatory changes to the 1915(i) state plan home and community
based services and imposes new requirements on what is considered an appropriate home/community
based residential setting for all the authorities in its scope. The crux of this final rule is to provide
person-centered requirements which identify the strengths, preferences and needs (clinical and
support), as well as the desired outcomes of the individual. The inclusion of defined HCBS residential
setting requirements is one part of this strategy.
The final rule took effect March 17, 2014. States are required to submit transition plans to CMS within
one year of the effective date indicating how they intend to comply with the new requirements within a
reasonable time period. If states amend or renew any waivers or state plan amendments in place prior
to the effective date, that action serves as a trigger for the state to submit a transition plan for all its
waivers under 1915(c), as well as any state plan amendments under 1915(i) or 1915(k) within 120 days
of the initial amendment/renewal submission.
The following is New York State’s statewide transition plan pursuant to this requirement.
Background
New York State operates 12 1915(c) waivers across the four major offices that oversee programs and
services to individuals who are aged and/or physically, behaviorally, mentally, developmentally or
intellectually disabled. These agencies/offices are the Department of Health (DOH), Office of Mental
Health (OMH), Office for People with Developmental Disabilities (OPWDD) and Office of Children and
Family Services (OCFS). In addition, the Office for Alcohol and Substance Abuse Services (OASAS) also
provides services to individuals in these waivers and participated in the development of the statewide
transition plan. We do not currently offer services through our state plan under a 1915(i) or 1915(k)
authority, although we have applied to CMS for approval of a 1915(k) Community First Choice Option
state plan amendment.
The following 1915(c) waivers are currently operating in New York State:
Long Term Home Health Care Program Waiver
Nursing Home Transition and Diversion Waiver
Traumatic Brain Injury Waiver
Care at Home Waivers (I, II, III, IV, and VI)
Bridges to Health (B2H) Waivers (B2H Serious Emotional Disturbances, B2H Developmental
Disabilities and B2H Medically Fragile)
OPWDD Home and Community Based Services
OMH/SED (Serious Emotional Disturbances) Children’s Waiver
In addition, the above agencies/offices offer significant home and community based LTSS through our
Medicaid state plan and, in the case of those operated by the DOH and the OPWDD, through 1115
demonstration waivers. We do not read the rule to apply to state plan services outside of 1915(i) and
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