SERVICE COORDINATION SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 3
4 min read

CONNECTING INDIVIDUALS WITH NEEDED SERVICES THROUGH COMPREHENSIVE COORDINATION AND SUPPORT

Service Coordination Services in New York assist individuals with disabilities, chronic conditions, or complex needs by managing and coordinating a range of services. The goal is to ensure that individuals receive holistic, person-centered care through integrated service planning and continuous support. Service Coordination 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 Service Coordination Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for coordination services targeting individuals with developmental disabilities.

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

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

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. SERVICE COORDINATION SERVICES OVERVIEW

Service Coordination involves assisting individuals and families in accessing a range of support services, advocating for client needs, and ensuring the effective implementation of care plans.

Approved providers may deliver:

Assessment and Planning: Identifying individual needs and developing comprehensive service plans.
Care Coordination: Managing access to healthcare, behavioral health, and community-based services.
Service Monitoring: Continuously evaluating the effectiveness of care plans and adjusting as necessary.
Crisis Intervention: Coordinating support during emergencies or health changes.
Resource Linkage: Connecting clients to community resources, healthcare providers, and social support networks.
Advocacy: Supporting client rights and promoting access to necessary services.
Transition Planning: Assisting with changes in living arrangements or care settings.
Documentation: Maintaining detailed records of assessments, service plans, and progress tracking.
Follow-Up and Evaluation: Regularly reviewing client progress and updating care plans.

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 Service Coordination provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for service planning, coordination, and client advocacy.
Ensure staff complete required background checks, health screenings, and training in care coordination.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Service Coordination Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including client assessment procedures, service coordination protocols, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Service Coordination 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
Service Coordination Policy & Procedure Manual including:
- Intake, assessment, and service planning protocols
- Care coordination, advocacy, and client support guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Crisis intervention and emergency response protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Service Coordination Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, healthcare administration, or a related field; experience in program management and care coordination.

Role: Service Coordinators

Requirements: Bachelor’s degree in social work, psychology, or related field; certification in case management preferred; experience in client advocacy; background clearance.

Role: Support Coordinators

Requirements: Experience in community resource coordination and client engagement; background clearance.

All staff must complete: