HOME AND COMMUNITY SUPPORT SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4
4 min read

PROMOTING INDEPENDENCE AND COMMUNITY ENGAGEMENT THROUGH PERSONALIZED SUPPORT SERVICES

Home and Community Support Services in New York assist individuals with disabilities, chronic conditions, or age-related challenges by providing tailored support to enhance daily living, social interaction, and community integration. These services are designed to empower individuals to maintain independence while remaining actively involved in their communities. Home and Community Support Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

Role: Administers Medicaid waiver funding for Home and Community Support Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for community-based support services targeting individuals with developmental disabilities.

Agency: New York State Office of Mental Health (OMH)

Role: Ensures compliance for community support programs serving individuals with mental and behavioral health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Home and Community Support Services meet quality, safety, and person-centered care standards.

2. HOME AND COMMUNITY SUPPORT SERVICES OVERVIEW

Home and Community Support Services focus on promoting independence and participation in community life through direct assistance, skill development, and support with daily living activities.

Approved providers may deliver:

Personal Assistance: Support with hygiene, grooming, mobility, and meal preparation.
Community Integration: Facilitating participation in social and recreational activities.
Life Skills Training: Teaching money management, communication, and problem-solving skills.
Companionship: Providing social interaction to reduce isolation and loneliness.
Health Monitoring: Assisting with medication reminders and basic health tracking.
Transportation Assistance: Helping individuals access community resources and appointments.
Safety and Supervision: Ensuring a safe environment during daily activities.
Respite Support: Offering short-term relief for primary caregivers.
Documentation: Maintaining records of care provided and progress tracking.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Home and Community Support provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for daily support, community engagement, and participant safety.
Ensure staff complete required background checks, health screenings, and training in community support.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Home and Community Support Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, support policies, and staff training documentation.

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including support protocols, safety standards, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Home and Community Support Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Home and Community Support Policy & Procedure Manual including:
- Daily support and community integration procedures
- Personal assistance and skill-building guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Safety, supervision, and emergency response protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Program Director

Requirements: Bachelor’s or Master’s degree in social work, healthcare administration, or human services; experience in community support program management.

Role: Community Support Specialists

Requirements: High school diploma or GED; experience in direct care, community support, or habilitation; background clearance.

Role: Personal Care Aides (PCAs)

Requirements: Completion of an approved PCA training program; experience in personal care and community engagement; background clearance.

All staff must complete: