New York - Day Habilitation Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New York State Office for People With Developmental Disabilities (OPWDD) authorizes Day Habilitation Services under the state's Comprehensive Home and Community-Based Services (HCBS) Waiver. This service provides structured daytime programming outside the individual's residence to build self-help, socialization, and adaptive skills, guided by a Staff Action Plan derived from a Care Coordination Organization (CCO) Life Plan.

Prospective agencies must first submit a Letter of Intent (LOI) and pass OPWDD's programmatic and fiscal review to obtain an Operating Certificate or Registered Provider status before applying for Medicaid enrollment. Agencies cannot enroll directly through the eMedNY portal without prior OPWDD authorization.

1. Service Definition and Scope

Day Habilitation in New York provides individuals with developmental disabilities structured activities outside their home environment. The service focuses on acquiring, retaining, or improving self-help, socialization, and adaptive skills necessary for community integration.

Services must be delivered according to a Staff Action Plan, which is developed based on the individual's overarching Life Plan created by their Care Manager.

• Target Population: Individuals with developmental disabilities enrolled in the OPWDD HCBS Waiver.
• Service Setting: Non-residential, community-based locations or OPWDD-certified facilities.
• Core Document: Staff Action Plan detailing specific goals, valued outcomes, and staff supports.
• Oversight Document: Life Plan finalized by a Care Coordination Organization (CCO) within 90 days of waiver enrollment.

2. Regulatory and Oversight Agencies

OPWDD is the primary operating agency for the HCBS waiver, responsible for programmatic approval, certification, and ongoing quality oversight of Day Habilitation providers.

The Department of Health (DOH) and the Office of the Medicaid Inspector General (OMIG) manage Medicaid enrollment, claims processing, and compliance auditing.

• Operating Agency: NYS Office for People With Developmental Disabilities (https://opwdd.ny.gov)
• Medicaid Enrollment: eMedNY Provider Services Portal (https://www.emedny.org)
• Compliance Oversight: NYS Office of the Medicaid Inspector General (https://omig.ny.gov)
• Background Checks: NYS Justice Center for the Protection of People with Special Needs (https://www.justicecenter.ny.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

New York requires prospective HCBS providers to undergo a rigorous pre-approval process through OPWDD before any Medicaid enrollment application is accepted. There is no direct-to-Medicaid enrollment path for this service.

Agencies must secure programmatic approval and establish a formal legal and operational framework recognized by OPWDD.

• Letter of Intent (LOI): Required submission to OPWDD to initiate the programmatic and fiscal review process.
• Corporate Authority: The agency's Certificate of Incorporation must include specific OPWDD operating language pursuant to Article 31 of the Mental Hygiene Law.
• Registered Provider Status: Applicants must complete and submit OPWDD Form 108 (Registered Provider Approval Request Form).
• Care Coordination Affiliation: Individuals served must be enrolled with a designated Care Coordination Organization (CCO) that generates the required Life Plan.

4. Licensure and Certification Requirements

Providers must obtain an Operating Certificate (OC) for facility-based programs or official Registered Provider status from OPWDD for community-based models.

The certification process involves environmental reviews for physical sites and comprehensive policy reviews to ensure compliance with state regulations.

• Application Form: OPWDD Form 108 (Rev. 3/2024) for Registered Provider Approval.
• Dedicated Communication: Agencies must establish a dedicated, non-personal email address for official OPWDD correspondence.
• Operating Certificate: Required prior to delivering services in facility-based Day Habilitation sites.
• Annual Update: Providers must submit an updated OPWDD Form 108 annually or whenever agency contracts change.

5. Medicaid Provider Enrollment

Once OPWDD approves the agency, it must enroll in the New York State Medicaid program via the eMedNY Provider Services Portal (PSP).

Day Habilitation providers enroll under a specific category of service and must pay an application fee unless a waiver applies.

• Enrollment Portal: eMedNY Provider Services Portal (PSP).
• Category of Service: 0269 (OPWDD Waiver Provider).
• Application Fee: $750 required at the time of initial enrollment.
• Required Form: ETIN Certification Statement for New Enrollments (EMEDNY-490602).
• Compliance Certification: Providers must certify adherence to NYS Social Services Law section 363-d and 18 NYCRR Part 521 regarding compliance programs.

6. Staffing, Training and Background Checks

New York State mandates strict background checks through the Justice Center for all direct care and administrative staff interacting with individuals receiving services.

Agencies must designate specific authorized personnel to manage and review these sensitive background checks.

• Criminal Background Check (CBC): Required for staff pursuant to Section 845-b of the Executive Law.
• Exclusion Screening: Justice Center Staff Exclusion List (SEL) check must be completed before hiring.
• Authorized Personnel: Agencies must submit the Authorized Person Designation Form to the CBC Unit to access SEL results.
• Revocation Requirement: Agencies must submit the Justice Center Authorized Person Revocation Form within 14 days if a designated person leaves their role.

7. Documentation, Policies and Records

OPWDD enforces strict documentation standards under ADM 2006-01R and subsequent updates for Day Habilitation services.

Failure to maintain precise, contemporaneous documentation directly linked to the individual's Life Plan will result in claim disallowances during audits.

• Staff Action Plan: Must include the individual's name, Medicaid CIN, agency name, and specific service provided.
• Life Plan Integration: Documentation must identify goals and valued outcomes derived directly from the CCO-generated Life Plan.
• Signatures: The printed name, signature, title, and date of the staff who wrote the Habilitation Plan are mandatory.
• Record Retention: Authorized person revocation forms and related background check records must be kept on file for six years.

8. Billing, Rates and Claims

Billing for Day Habilitation is processed through the eMedNY system using the Electronic Provider Assisted Claim Entry System (ePACES).

Providers must ensure all service documentation is fully executed prior to the date of service to support Medicaid claims.

• Claim System: Electronic Provider Assisted Claim Entry System (ePACES).
• Transmission ID: Electronic Transmitter Identification Number (ETIN) required for all billing providers.
• Payment Setup: Electronic Funds Transfer (EFT) Authorization is required during eMedNY enrollment.
• Audit Protocol: Claims are strictly disallowed under OPWDD Audit Protocol if the Staff Action Plan is not in place prior to the service date.

9. Approval Sequence and Timeline

The approval process is sequential, requiring OPWDD programmatic authorization before Medicaid enrollment can be initiated.

Timelines depend heavily on the completeness of the initial LOI and the scheduling of site surveys for facility-based programs.

• Step 1: Submit Letter of Intent (LOI) and programmatic/fiscal proposals to OPWDD.
• Step 2: Obtain OPWDD Operating Certificate or Registered Provider status via Form 108.
• Step 3: Submit the eMedNY enrollment application with the $750 fee and ETIN certification.
• Step 4: Finalize Life Plans with CCOs within 90 days of HCBS waiver enrollment to begin service delivery.

10. Common Denials and Survey Findings

OPWDD and OMIG frequently audit Day Habilitation providers, focusing heavily on the presence and accuracy of service documentation.

Missing or incomplete Staff Action Plans are the most common cause for immediate claim disallowances.

• Missing Plans: Claims are disallowed if no Day Habilitation plan/staff action plan is in effect on the actual service date.
• Incomplete Elements: Disallowance occurs for missing the Medicaid CIN, date of review, or specific valued outcomes in the documentation.
• Background Check Failures: Citations for allowing staff to work before receiving clearance from the Justice Center SEL.
• Life Plan Discrepancies: Failure to demonstrate due diligence in correcting inaccuracies in the finalized Life Plan with the Care Manager.

11. Key Contacts and Resources

Providers must utilize official New York State portals for enrollment, background checks, and compliance updates.

Maintaining access to these systems and monitoring official communications is critical for ongoing regulatory adherence.

• OPWDD Provider Information: https://opwdd.ny.gov
• eMedNY Provider Portal: https://www.emedny.org
• NYS Office of the Medicaid Inspector General (OMIG): https://omig.ny.gov
• NYS Justice Center for the Protection of People with Special Needs: https://www.justicecenter.ny.gov

See all New York services · New York Medicaid consulting · book a consultation.