14 CRR-NY 635-12.12NY-CRR
STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 14. DEPARTMENT OF MENTAL HYGIENE
CHAPTER XIV. OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
PART 635. GENERAL QUALITY CONTROL AND ADMINISTRATIVE REQUIREMENTS APPLICABLE TO PROGRAMS, SERVICES OR FACILITIES FUNDED OR CERTIFIED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
SUBPART 635-12. LIABILITY FOR SERVICES
14 CRR-NY 635-12.12
14 CRR-NY 635-12.12
635-12.12 Limited exception for supported employment services and respite services.
Prior to July 1, 2015, the limited exception provisions in this section were applicable to individuals applying for supported employment services who met specified criteria. The limited exception is no longer permitted for individuals enrolling in supported employment services on and after July 1, 2015.
(a) The provisions of sections 635-12.2--635-12.10 of this Subpart are not applicable in the circumstances in either paragraph (1) or paragraph (2) of this subdivision:
(1) Supported employment services. The individual is enrolled in supported employment services and all of the following conditions are met:
(i) either:
(a) the individual was enrolled in supported employment services prior to July 1, 2015, and was continuously enrolled in supported employment services with the same provider on and after July 1, 2015; or
(b) the individual was enrolled in supported employment services prior to July 1, 2015, and on or after July 1, 2015 the provider downsized or eliminated the provision of supported employment services, causing the individual to dis-enroll in that provider’s supported employment services and re-enroll in supported employment services from the same or a different provider.
(ii) the individual is not enrolled in any of the following services:
(a) Medicaid Service Coordination;
(b) day treatment services;
(c) residential habilitation provided in an individualized residential alternative (IRA), community residence (CR), or family care home;
(d) hourly community habilitation;
(e) day habilitation services;
(f) site based prevocational services;
(g) community prevocational services;
(h) respite services.
Note:
This list of services previously included at-home residential habilitation, community habilitation phase II, and blended and comprehensive services, which have been discontinued.
(iii) the individual was not enrolled in the HCBS Waiver at any time on or after March 15, 2010.
(2) Respite services. The individual is applying for or enrolled in respite services and all of the following conditions are met:
(i) The individual is not enrolled in any of the following services:
(a) Medicaid Service Coordination;
(b) day treatment services;
(c) residential habilitation provided in an IRA, CR, or family care home;
(d) hourly community habilitation;
(e) day habilitation services;
(f) site based prevocational services;
(g) community prevocational services;
(h) supported employment services.
Note:
This list of services previously included at-home residential habilitation, community habilitation phase II, and blended and comprehensive services, which have been discontinued.
(ii) The individual was not enrolled in the HCBS Waiver at any time on or after March 15, 2010.
(b) Notice requirements. All notices specified in this subdivision shall be in the form and format specified by OPWDD.
(1) Respite. Providers of respite services shall notify all individuals applying for respite services, who appear to meet the requirements for the limited exception set forth in paragraph (a)(2) of this section, about the limited exception and the obligation of the individual to notify the provider if he or she applies for other services.
(2) Supported employment services. Providers shall notify all individuals who are qualified for the limited exception on July 1, 2015 about the changes in criteria for qualification for the limited exception for supported employment. The notice must be provided to all such individuals no later than August 1, 2015.
(c) Supported employment services--individuals applying for other services.
(1) If an individual enrolled in supported employment services meets the criteria specified in paragraph (a)(1) of this section, and applies for another service specified in such paragraph, the individual and the provider of other services receiving the application must notify the provider of the supported employment services that such application has been made.
(2) Prior to the receipt of the other services, the provider of the other services and the provider of supported employment services (if the provider of supported employment services is aware of the individual's application for another service) shall give notice to the individual and liable parties, if known. The notice shall be in the form and format specified by OPWDD and shall include information about the following:
(i) that the limited exception will no longer be in effect if the person who is enrolled in supported employment services enrolls in any of the other services;
(ii) the provisions of clause (a)(1)(i)(b) of this section concerning individuals who were enrolled in supported employment prior to July 1, 2015 and who switch providers of supported employment on or after July 1, 2015; and
(iii) information about the obligations of the individual and liable parties when the individual enrolls in other services and potential consequences of failure to comply with such obligations.
(3) If the individual enrolls in any of the other services in addition to the supported employment services, the limited exception is no longer in effect and the provisions of sections 635-12.2--635-12.10 of this Subpart are applicable, effective on the date the person begins to receive the other services.
(4) The obligations of the individual and liable parties to pay for the supported employment services as specified in section 635-12.6 or 635-12.7 of this Subpart starts on the date the person enrolls in the other services or, if the supported employment services are preexisting services, on June 15, 2010 (if it is later).
(5) An individual who was enrolled in supported employment services prior to July 1, 2015, who is also enrolled in any of the other services specified in paragraph (a)(1) or (2) of this section may stop receiving the other service(s). If all of the criteria specified in paragraph (a)(1) or (2) of this section are met, the provisions of sections 635-12.2 through 635-12.10 of this Subpart will no longer be applicable, effective the date the person dis-enrolls from all such other services. This does not apply to individuals who enroll in supported employment services on or after July 1, 2015. These individuals are not eligible for the limited exception described in this section.
(d) Respite services--individuals applying for other services.
(1) If an individual is applying for or enrolled in respite services, meets or is expected to meet the criteria specified in paragraph (a)(2) of this section, and applies for another service specified in such paragraph, the individual and the provider of other services receiving the application must notify the provider of the respite services that such application has been made.
(2) Prior to the receipt of the other services, the provider of the other services and the provider of respite services (if the provider of respite services is aware of the individual's application for another service) shall give notice to the individual and liable parties, if known. the notice shall be in the form and format specified by OPWDD, and shall include information that the limited exception will no longer be in effect if the person who is enrolled in respite services enrolls in any of the other services, and information about the obligations of the person and liable parties that would then be required and potential consequences of failure to comply.
(3) If the individual enrolls in any of the other services in addition to the respite services, the limited exception is no longer in effect and the provisions of sections 635-10.2--635-10.10 of this Subpart are applicable, effective on the date the person begins to receive the other services.
(4) The obligations of the individual and liable parties to pay for the respite services as specified in section 635-12.6 or 635-12.7 of this Subpart starts on the date the person enrolls in the other services or, if the respite services are preexisting services, on June 15, 2010 (if it is later).
(5) An individual enrolled in respite services who is also enrolled in any of the other services specified in paragraph (a)(1) or (2) of this section, as applicable, may stop receiving the other service(s). If all of the criteria specified in paragraph (a)(1) or (2) of this section are met, the provisions of sections 635-12.2--635-12.10 of this Subpart will no longer be applicable, effective the date the person dis-enrolls from all such other specified services.
14 CRR-NY 635-12.12
Current through June 30, 2021
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