Office of Children and Family Services

Bridges to Health

Home and Community-Based Services Waiver Program "Bridges to Health" (B2H)

Bridges to Health (B2H) Frequently Asked Questions

  1. Upon receiving a referral from LDSS, a representative from the HCIA meets the potential family, at which time the HCIA representative presents the list of potential HCIs and asks the family to complete the Understanding the Bridges to Health Medicaid Waiver Program (OCFS 8002). If the HCIA can not meet with the family until day 14, is it accurate that the HCI needs to be assigned and complete all the information as indicated on pg. 2-5 under the preliminary IHP in 11 days?

    Answer: Yes. Per Chap. 6-4 of the Bridges to Health Program Manual, once a child has been referred to an HCIA by the LDSS for assessment and completion of an Application for Enrollment Packet, the HCIA directs the preparation of the packet. The process begins by meeting with the child/medical consenter and other caregivers to discuss B2H. Within 60 days of referral from the LDSS, the HCIA is responsible for the accurate and appropriate completion of the Application for Enrollment Packet. Completed packets must be submitted to the HCIA supervisor and quality management staff for review and submittal to the LDSS for approval. The Application for Enrollment Packet includes:

    • Understanding the Bridges to Health Medicaid Waiver Program Form (OCFS-8002)
    • Level of Care (OCFS-8005 A, C, or OMRDD 02-02-97)
    • Freedom of Choice Form (OCFS-8003)
    • Health Care Integrator Selection Form (OCFS-8007)
    • Waiver Participants’ Rights Form (OCFS-8008)
    • Individualized Health Plan (Preliminary IHP OCFS-8017)
  2. The services of Prevocational and Supported Employment are geared towards youth with “severe disabilities”. Will youth with serious emotional disturbance (SED) qualify under this definition, or is it only for youth with developmental disabilities?

    Answer: These services can be provided to youth with an SED and MedF. The youth does not have to enroll in B2H through the DD waiver to receive these services.

  3. If a child is in Therapeutic Foster Care and B2H simultaneously and requires respite in another foster home (certified as a B2H respite provider), who pays for the respite?

    Answer: If the approved IHP includes respite, and it lists this particular home (agency) as a B2H provider and the provider meets the qualifications outlined in the B2H Program Manual to provide out of home respite, then B2H will cover the cost of the respite as long as it falls within the approved billable units in the IHP.

  4. On Waiver Services Provider Form (OCFS 8035) Schedule A, proposed WSPs indicated the types of services they could provide, as well as the counties where the services will be available. If a WSP chooses to expand service areas to include more counties, or desires to increase the types of services available, and they meet the established qualifications, does the HCIA need to inform OCFS?

    Answer: The WSP must complete a new Schedule A form and send it to the HCIA, who in turn verifies that the WSP is qualified to perform a new service. The HCIA must send a copy of the Schedule A to the Regional QMS and OCFS Bureau of Waiver Management.

  5. On the Detailed Service Plan (OCFS 8020), are we identifying the WSP agency or individual employees of the WSP?

    Answer: The Detailed Service Plan provides space for the WSP and the individual providing the service.

  6. Can children receive B2H services outside of the designated B2H region?

    Answer: A child may receive B2H services outside the B2H designated region, but cannot reside outside the Region. Service providers must be within a reasonable proximity to the child’s home.

  7. WSPs are hesitant to contract to provide waiver services unless they can decide which children they can or want to serve. Does the WSP have that option?

    Answer: WSP cannot refuse to serve a child.

  8. The B2H Program Manual notes that a provider must submit a Service Summary Form (OCFS 8018) before the next service occurs. What about the cases where there is a service that occurs two or three days in a row? Does there need to be a Service Summary sent out daily before the next occurs?

    Answer: For every B2H Waiver service delivered to an enrolled child or family member, the worker must complete a Service Summary. Medicaid requires that service documentation be contemporaneous with service provision. The summaries must be complete and timely and must accurately relate to and identify the child’s service plan goals and objectives. Original Service Summaries must be submitted to the HCIA within five business days of the service contact.

  9. There is a progress note function in CONNECTIONS. How does this interface with the B2H progress note template?

    Answer: The Progress Note (OCFS 8019) is documentation that captures all contacts beyond the Service Summary that HCIs or WSPs have on behalf of or with the child/medical consenter or family/caregiver. It summarizes all relevant information outside the billing information. At this time, it does not interface with CONNECTIONS.

  10. The HCIA will be assigned a role in CONNECTIONS by the LDSS. The HCI will document significant information relevant to the Case Planner/Manager via the CONNECTIONS Progress Notes. These notes should be printed and made part of the B2H case record.

  11. Will WSPs be assigned a role in CONNECTIONS?

    Answer: Not at this time.

  12. Foster care providers have been given specific directions about what can be included in CONNECTIONS progress notes when they call the SCR. Should HCIs document calls to the SCR in CONNECTIONS progress notes?

    Answer: Agencies should continue to use procedures already in place for entering progress notes into CONNECTIONS. HCIs will document the information on a hard copy B2H Progress Notes Form (OCFS 8019) and a B2H Serious Reportable Incident Form (OCFS 8021).

  13. Can staff be paid for time they spend in required B2H training prior to working with youth and at what rate?

    Answer: Staff training is part of professional development. It is not directly compensated, but training is figured into the rates reimbursed for services once a child is receiving the B2H Waiver.

  14. If staff received CANS B2H Certification Training, can those staff then train future HCIs? If not, how often will the CANS B2H Certification be offered? If staff received certification in other CANS versions, does this meet B2H requirements?

    Answer: Trainers must complete the CANS B2H Train the Trainer (TOT) to teach others to administer the CANS B2H. OCFS anticipates a training for Train the Trainers (TOT) next year. Those trained in other versions of CANS (eg: CANS-MH) must attend the CANS Basic as the CANS B2H is somewhat different than other versions. As for other training opportunities, there will be a CANS B2H training website available early in 2008.

  15. Please clarify issues related to the training entitled "Overview of B2H Waiver Documentation." On page 14-1 of the Program Manual, it states, "All WSPs, including staff hired by the HCIA, are required to have appropriate training in the following areas prior to providing B2H services:
    • First Aid/ CPR
    • Mandated Reporting on Suspected Child Abuse and Neglect
    • Basic Crisis Intervention and De-escalation Techniques
    • Overview of B2H Waiver Program Documentation Requirements"

    Then, according to page 14-2, the Program Manual reads: "All WSPs are required to attend the following trainings within the first six months of engagement as a B2H provider:

    • B2H Documentation: 4 hours
    • Working in a Family's Home: 4 hours"

    Answer: All HCIs and WSPs require B2H Documentation Training. Page 14-3 of the B2H Program Manual explains that ALL HCI supervisors MUST attend and satisfactorily complete the OCFS sponsored 3 day training (Training #4) PRIOR to providing ANY supervision to HCI staff. It is preferred that HCIs also attend the 3 day training (Training #4) prior to providing services to B2H children, but it is understood that staffing lags may occur within the initial rollout of the B2H program. The HCI MUST attend the 3 day training within their first 6 months of B2H employment.

  16. Please clarify who needs to be trained in B2H Documentation, how soon after their date of hire, who provides that particular training, and when it is offered (i.e. is it a part of the 3 day training?).

    Answer: See Question #14

  17. Many of our current staff, who may be hired as HCIs, have already been trained in Universal Precautions and Hazardous Materials, Recognizing and Understanding Cultural Differences and Diversity, Communication Skills and Advocacy, Understanding and Managing Behaviors, Advanced Crisis Intervention/Avoidance and Child Adolescent Development. Do those staff need to repeat these trainings to work as HCIs?

    Answer: If any potential HCI hires have previously and satisfactorily attended one or more of the (HCIA sponsored) required trainings, attendance must be formally documented and the training must be current and preferably within the last six months, then such previous trainings would suffice. If any of these trainings require refreshers or annual updates, then those staff would need to attend the refreshers/updates.

  18. The HCIA is responsible for ensuring that HCI staff and WSP staff have received mandated reporting training, first aid training and Crisis Intervention training. What kind of documentation is required to demonstrate such requirements have been met? What constitutes "crisis intervention training?" Is there a specific curriculum that is required?

    Answer: Documentation of satisfactory attendance and completion of required B2H training must be formally tracked by the HCIA and WSP, as well as documentation of satisfactory attendance and completion in each staff members personnel file. Staff members that have already received Crisis Intervention through an already established and OCFS approved model may continue to use this model.

  19. Do foster parents need to attend the B2H Respite Training, B2H Documentation Training and Working in a Family Home Training to provide respite?

    Answer: Chapter 8 of the B2H Program Manual, pages 8-12, 13 and 8-17, 18, Training Requirements, specify that respite providers, within six months of engagement as a B2H provider, are expected to attend these trainings.

  20. At what rate do HCIAs bill for the work the HCIA/HCI does for youth prior to enrollment?

    Answer: No services can begin before the child is officially enrolled in the B2H Waiver Program. However, once enrolled in B2H, the HCI manages the child’s B2H services on a monthly basis. To account for the additional work preformed by the HCI during the child’s enrollment, a bill using the First Month Transition rate code may be submitted for the enrollment month in addition to the bill for the normal Health Care Integration services (see pg. 13-4 of the B2H Program Manual).

  21. In Chapter 5 of the B2H Program Manual, page 5-12, #3 indicates that HCIAs are required to report on "Waiver budgets that include the average cost for all waiver participants..." Is the HCIA responsible for tracking detailed expenditures on each child?

    Answer: Chapter 5, pg 5-10 of the B2H Program Manual speaks to the Quality Management functions of the HCIA. The HCIA is responsible for reviewing all the documentation bulleted for appropriate and efficient use of services. Three of the documents listed will be used for billing reconciliation: IHP (OCFS-8017), Detailed Service Plan (OCFS-8020) and Service Summary Form (OCFS- 8018). The HCIA, per the Provider Agreement with OCFS and per the Model Subcontract with any WSP, is responsible to reconcile that the services that are billed for are done so appropriately and accurately. The information on page 5-12, is the information that the HCIA is required to report to OCFS. Although this report does not include individualized budget information, it does not remove the responsibility of reconciling billing and approved services from the HCIA.

  22. Can OCFS create an EXCEL spreadsheet for the billing/budget portion of the IHP.

    Answer: CONNECTIONS will provide this functionality in March 2008.

  23. How often will the HCIA or WSP receive Medicaid payments?

    Answer: According to the Department of Health (DOH), once submitted, payment can be expected in about 4-6 weeks.

  24. If the WSP is billing Medicaid directly, regardless of the Service Summary Form (OCFS 8018), HCIAs have no control over what is billed. How would the HCIA know what is being billed, if the HCIA does not see a copy of what is sent to eMedNY?

    Answer: Medicaid Adjudicated Claim Reports will be provided to the HCIAs for all B2H children served by the HCIA.

  25. Are HCIAs responsible for capturing costs or revenues?

    Answer: HCIAs are expected to track revenues and expenditures related to the B2H program and to report them as part of the Standards of Payment (SOP) submission in a separate non Maximum State Aid Rate (MSAR) cost center.

  26. Are the B2H rates fixed or based on costs?

    Answer: B2H rates are fee-based rates. They are not determined based on program-specific costs.

  27. Are HCIAs expected to gather paper verification of background checks and SCR clearances from WSPs for each person they may have working with families, OR is it sufficient to have a record on file at the HCIA that verifies that the WSP conducts background checks and SCR clearances for each of their employees?

    Answer: Per the Model Subcontract for the B2H Waiver, under Section II, Scope of Services, number five states: “The agency warrants that it and its staff have all the necessary licenses, approvals and certifications currently required by the laws of any applicable municipality of local, state or federal government. The agency further agrees to keep such required licenses, approvals and certificates in full force and effect during the term of this Agreement or any extension time frames. The Agency shall promptly notify the HCIA of any enforcement action taken with respect of such license, approval or certificate and any action the Agency is taking with respect thereto….” This references the fact that the WSP is responsible for the paper verification of checks, and it is sufficient to have the contract on file that the HCIA has verified through the contract as such.

  28. When HCIAs hire HCIs who currently work in their agency, are existing background checks and clearances sufficient or do they need to be current and completed in 2008?

    Answer: If a current employee of the HCIA is transferred to work in that same agency as an HCI, that employee is not required to have an updated background check done by the SCR.

  29. Do B2H forms and procedures for documenting incident reporting supercede NYS, because we are responding to federal requirements?

    Answer: No

  30. What agency completes OCFS Forms 8003, 8007 and 8008? The HCIA representative or the assigned HCI?

    Answer: HCIA originates and completes each of these forms.

  31. Is there a form for safeguards that the HCI can use when explaining safeguards to the child/medical consenter?

    Answer: There is no form. Chapter 11 in the B2H Program Manual, page 11-1, refers to HCI responsibilities regarding what information must be provided to the child/medical consenter.

  32. Will HCIAs and WSPs receive new Medicaid provider numbers once the eMedNY Application is completed?

    Answer: Yes, a new number and locater code will be issued by DOH.

  33. What happens in terms of Medicaid eligibility for the waiver if a child has income (e.g.: a trust or survivor benefits)? Can the child qualify for the waiver?

    Answer: Yes, the child can qualify for the waiver, but must spend down first.

  34. Does the Medication Administration Record (MAR) replace what exists for agencies that have medication administration procedures, or does it need to be added to the B2H paper case file? More specifically, is administering medication a function of the foster care provider and included in Medicaid state plan services and documentation requirements? If so, would a progress note be a sufficient means of documenting an HCI becoming aware of an error in medication?

    Answer: Medication Administration Record (MAR) is the standard for documenting medication administration. Administering medications is a function of the foster care provider. A progress note is not a sufficient means of documenting a medication error. Medication errors must be documented on the Medication Error Report (OCFS 8036.)

  35. According to page 10-6 of the B2H Manual, an 80% achievement rate of progress towards goals and percentage of time frames met is considered acceptable. What happens if an 80% achievement rate is not met?

    Answer: OCFS will undertake a review of the HCIA to devise a plan to improve the achievement rate.

  36. Are children on trial discharge eligible for B2H services?

    Answer: B2H criteria states that as long as they are still in the custody of the LDSS or OCFS, they are eligible to receive B2H services.