Comprehensive Home and Community-Based Services Waiver (1915-c HCBS)

Generated from the gc-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.

Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant.

• Owner record: ny/opwdd-comprehensive-hcbs-waiver
• Jurisdiction code: NY
• Frame: care_recipient
• Review by: 2026-11-10
• Authority: opwdd-hcbs-1915c
• Also called: OPWDD HCBS Waiver

Offering 1: respite

Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant.

• Availability (owner codes): {"checked": null, "intake": "unknown", "type": "unknown"}
• Amounts (as stated by the owner): []

Conditions:

• All of these:
• Fact rule: recipient.disability is true
• Fact rule: recipient.medicaid_eligible is true
• Stated condition, not checked automatically: "The OPWDD Waiver services individuals with an Intellectual Disability or Developmental Disability, or Both"
• Stated condition, not checked automatically: "Have a developmental disability as defined by New York State Mental Hygiene Law Section 1.03 (22) that originated before the age of 22; has continued or can be expected to continue indefinitely; and constitutes as a substantial handicap to such person’s ability to function normally in society"
• Stated condition, not checked automatically: "Be in a Medicaid eligibility group that is eligible to enroll in Medicaid as described in the OPWDD HCBS Waiver and defined in SSA §§ 1634(c) and 1902(a)(10)(A)(i) and (ii) and 42 CFR Part 435"
• Stated condition, not checked automatically: "Need a Level of Care that would be provided in an Intermediate Care Facility for Individuals with Intellectual and/or Developmental Disabilities (ICF/IID)"
• Stated condition, not checked automatically: "Reside in NYS and live in an appropriate living arrangement (and/or be residing in an appropriate living arrangement once enrolled in the HCBS waiver) as per OPWDD's waiver regulations"
• Stated condition, not checked automatically: "Not be enrolled in another HCBS Waiver or Managed Long-Term Care (MLTC) Plan as described in 42 CFR §433 Subpart D; and"
• Stated condition, not checked automatically: "Meet the requirement of a Reasonable Indication of Need for Services as defined in 42 CFR §441.302(c) and described in the OPWDD HCBS Waiver"
• Stated condition, not checked automatically: "At the time of enrollment, you must live at home or in a certified Family Care home, community residence or group home."
• Stated condition, not checked automatically: "Services provided to participants unable to care for themselves"
• Stated condition, not checked automatically: "Respite care is not furnished or provided for the purpose of compensating relief or substitute staff in certified community residences."

Access route 1.1

• Where: NY
• How: To receive the supports and services offered through the HCBS Waiver, you will need to enroll in the program. To request enrollment, you must fill out and submit an Application for Participation.
• Url: https://opwdd.ny.gov/apply-home-and-community-based-services-waiver
• Phone: null

Evidence

• /name: "Comprehensive Home and Community-Based Services Waiver (1915-c HCBS)" (source, capture 48ef87984257d19c1133632e4502db100cda98184d158ee75e4b5dcae612ae6b)
• /caregiving_effect: "| APPENDIX OPWDD Comprehensive Waiver Services |\n| --- |\n| Service | Description |\n| Residential Habilitation | Individually tailored supports that assist with the acquisition, retention or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living (hands-on), community inclusion and relationship building, training and support for independence in travel, transportation, adult educational supports, social skills, leisure skills, self-advocacy and informed choice skills, and appropriate behavior development that assists the participant to reside in the most integrated setting appropriate to his/her needs. Residential Habilitation services are limited to individuals who reside in OPWDD certified residential settings. |\n| Community Habilitation | Services occurring largely in community (non-certified) settings to facilitate and promote independence and community integration. Community habilitation is defined as a face-to-face service and offers skills training and supports including adaptive skill development, assistance with activities of daily living, travel, health, adult educational supports, communication, social skills, leisure skills, money management, socially appropriate behaviors, life safety, self-advocacy, informed choice, community inclusion, and relationship building |\n| Day Habilitation | Day Habilitation services include assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, including communication, travel, and adult education that regularly takes place in a non-residential setting, separate from the person's private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy, and informed choice. Day habilitation services may also be used to provide supportive retirement activities, including: altering schedules to allow for more rest time throughout the day, support to participate in hobbies, clubs and/or other senior related activities in their communities. A supplemental version of Day Habilitation is available for individuals who do not reside in a certified 24/7 location, including services occurring at night and on the weekend. OPWDD Day Habilitation can be provided on-site or \"without walls\" in the community. |\n| Pathway to Employment | A person-centered, comprehensive career planning and support service that provides assistance for individuals to obtain, maintain, or advance in competitive employment or self-employment. It is a focused, time-limited service that engages a participant in identifying a career direction, provides instruction and training in pre-employment skills, and develops a plan for achieving competitive, integrated employment at or above the state minimum wage. Within 12 months or sooner, the outcome of this service is documentation of the individual's stated career objective; a detailed career plan used to guide individual employment supports; and preparation for supported employment services that assist an individual in obtaining, maintaining, or advancing in competitive employment or self- employment. |\n| Prevocational Services (Site-Based and Community) | Services that provide learning and work experiences, including volunteering, where participants can develop general, non-job task specific strengths and skills that contribute to employability in paid employment in integrated community settings and increase levels of independence. Services are expected to occur over a defined period of time based upon a person-centered planning process. Services include activities that are not primarily directed at teaching skills to perform a particular job, but at underlying habilitative goals (e.g., attention span, motor skills, interpersonal relations with co-workers and supervisors) that are associated with building skills necessary to perform work and optimally to perform competitive, integrated employment. There are two separate types of prevocational services: Site-Based Prevocational Services and Community Prevocational Services. Site-based prevocational services are delivered in OPWDD certified non-residential facilities. Community prevocational services are provided primarily in community settings. |\n| Supported Employment (SEMP) | Ongoing support to participants who need continuous support to obtain and maintain a job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce for which an individual is compensated at or above the state minimum wage. The outcome of this service is paid employment at or above the state minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals; as such, career planning is also an allowable service activity. Supported employment services may include any combination of the following services: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching, benefits support, training and planning, transportation, asset development and career advancement services, and other workplace support services including services not specifically related to job skill training that enable the individual to be successful in integrating into the job setting. |\n| Respite | Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant. Respite care is not furnished or provided for the purpose of compensating relief or substitute staff in certified community residences. |\n| Assistive Technology - Adaptive Devices | An item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants. These services directly assist a participant in the selection, acquisition, or use of an assistive technology device. The devices and services must be documented in the individual's Life Plan as being essential to their habilitation, ability to function, or safety, and essential to avoid or delay institutionalization. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Home-Enabling Supports (HES) is a sub-service added to Assistive Technology-Adaptive Devices service effective 10/1/23. Home-Enabling Supports are alternative services, equipment, or supplies which improve and maintain the individual's opportunities for full membership in the community. HES funds items and services that decrease the need for other Medicaid services, promote inclusion in the community, and/or increase the individual's safety and independence in the home environment. Examples of HES may be smart home devices, remote monitoring for the purposes of health and safety, or medical triage services. |\n| Intensive Behavioral Services | Intensive behavioral services are short-term, outcome-oriented, and of higher intensity than other behavioral interventions and are focused on developing effective behavioral management strategies to ensure health and safety and/or improve quality of life. Available under the following circumstances: 1. For individuals who reside in a non-certified residential location, their own home or family home, or a family care home; and 2. The individual or a party acting on behalf of the individual certifies through written documentation that the individual is at risk of imminent placement in a more restrictive living environment due to challenging behavioral episodes. |\n| Environmental Modifications (Home Accessibility) | Physical adaptations to the individual's home, required by the individual's Life Plan, that are necessary to ensure the health, welfare and safety of the individual, or that enable the individual to function with greater independence in the home, and without which the person would require institutionalization and/or more restrictive and expensive living arrangement. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Some modifications may include installation of ramps, hand rails and grab-bars, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies needed for the welfare of the recipient, lifts and related equipment, modifications of the kitchen necessary for the individual to function more independently in his home, strobe light smoke detection and alarm devices. |\n| Vehicle Modifications | Physical adaptations to the individual's primary vehicle, required by the individual's Life Plan, that are necessary to ensure the health, welfare, and safety of the individual or that enable the individual to function with greater independence. These physical adaptations may include portable electric/hydraulic and manual lifts, ramps, and ancillary equipment or modifications necessary to guarantee full access to, and safety in, a motor vehicle. |\n| Family Education and Training | Training given to families of individuals enrolled in the HCBS waiver is intended to enhance the decision-making capacity of the family unit, provide orientation regarding the nature and impact of an intellectual or developmental disability on the individual and their family, including behavioral management practices, and teach the family about service alternatives. The purpose is to support the family unit in understanding and coping with the intellectual or developmental disability and create a supportive environment at home to decrease premature residential placement outside the home. |\n| Community Transition Services | Non-recurring set-up expenses for individuals who are transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence in the community, where the person is directly responsible for his or her own living expenses. Allowable expenses are those reasonable and necessary to enable a person to establish a basic household. Allowable items include security deposits that are required to obtain a lease on an apartment or home, essential household furnishings, set-up fees or deposits for utility or service access, and moving expenses. |\n| Live-in Caregiver | An unrelated care provider who resides in the same household as the individual and provides supports to address the individual's physical, social or emotional needs in order for them to live safely and successfully in their own home. The Live-in Caregiver must be unrelated to the individual by blood or marriage. |\n| Fiscal Intermediary (FI) | The fiscal intermediary supports the individual self-directing their HCBS services with billing and payment of approved goods and services, fiscal accounting and reporting, ensuring Medicaid and corporate compliance, and general administrative supports. |\n| Individual Directed Goods and Services (IDGS) | Services, equipment, or supplies not otherwise provided through this waiver or through the Medicaid State Plan that addresses an identified need in an individual's Life Plan, which includes improving and maintaining the individual's opportunities for full membership in the community. Individuals who choose to self-direct their services with budget authority may receive IDGS as a waiver service. Individuals may manage their IDGS budget, as described in their Life Plan, to fully purchase or put funds towards their personal fiscal resources to purchase items or services which meet the criteria as described in the waiver. |\n| Support Brokerage | Assist individuals (or the individual's family or representative as appropriate) to self-direct and manage some or all of their waiver services. The support broker assists the individual in the day-to- day management of services and provides support and training to the individuals and their family regarding the ongoing decisions and tasks associated with self-direction. |" (source, capture b087a1e5a4f8bf59d300b6dddbd637d102cf93ff68775464326c346dbe26262f)
• /offerings/0/summary: "| APPENDIX OPWDD Comprehensive Waiver Services |\n| --- |\n| Service | Description |\n| Residential Habilitation | Individually tailored supports that assist with the acquisition, retention or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living (hands-on), community inclusion and relationship building, training and support for independence in travel, transportation, adult educational supports, social skills, leisure skills, self-advocacy and informed choice skills, and appropriate behavior development that assists the participant to reside in the most integrated setting appropriate to his/her needs. Residential Habilitation services are limited to individuals who reside in OPWDD certified residential settings. |\n| Community Habilitation | Services occurring largely in community (non-certified) settings to facilitate and promote independence and community integration. Community habilitation is defined as a face-to-face service and offers skills training and supports including adaptive skill development, assistance with activities of daily living, travel, health, adult educational supports, communication, social skills, leisure skills, money management, socially appropriate behaviors, life safety, self-advocacy, informed choice, community inclusion, and relationship building |\n| Day Habilitation | Day Habilitation services include assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, including communication, travel, and adult education that regularly takes place in a non-residential setting, separate from the person's private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy, and informed choice. Day habilitation services may also be used to provide supportive retirement activities, including: altering schedules to allow for more rest time throughout the day, support to participate in hobbies, clubs and/or other senior related activities in their communities. A supplemental version of Day Habilitation is available for individuals who do not reside in a certified 24/7 location, including services occurring at night and on the weekend. OPWDD Day Habilitation can be provided on-site or \"without walls\" in the community. |\n| Pathway to Employment | A person-centered, comprehensive career planning and support service that provides assistance for individuals to obtain, maintain, or advance in competitive employment or self-employment. It is a focused, time-limited service that engages a participant in identifying a career direction, provides instruction and training in pre-employment skills, and develops a plan for achieving competitive, integrated employment at or above the state minimum wage. Within 12 months or sooner, the outcome of this service is documentation of the individual's stated career objective; a detailed career plan used to guide individual employment supports; and preparation for supported employment services that assist an individual in obtaining, maintaining, or advancing in competitive employment or self- employment. |\n| Prevocational Services (Site-Based and Community) | Services that provide learning and work experiences, including volunteering, where participants can develop general, non-job task specific strengths and skills that contribute to employability in paid employment in integrated community settings and increase levels of independence. Services are expected to occur over a defined period of time based upon a person-centered planning process. Services include activities that are not primarily directed at teaching skills to perform a particular job, but at underlying habilitative goals (e.g., attention span, motor skills, interpersonal relations with co-workers and supervisors) that are associated with building skills necessary to perform work and optimally to perform competitive, integrated employment. There are two separate types of prevocational services: Site-Based Prevocational Services and Community Prevocational Services. Site-based prevocational services are delivered in OPWDD certified non-residential facilities. Community prevocational services are provided primarily in community settings. |\n| Supported Employment (SEMP) | Ongoing support to participants who need continuous support to obtain and maintain a job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce for which an individual is compensated at or above the state minimum wage. The outcome of this service is paid employment at or above the state minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals; as such, career planning is also an allowable service activity. Supported employment services may include any combination of the following services: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching, benefits support, training and planning, transportation, asset development and career advancement services, and other workplace support services including services not specifically related to job skill training that enable the individual to be successful in integrating into the job setting. |\n| Respite | Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant. Respite care is not furnished or provided for the purpose of compensating relief or substitute staff in certified community residences. |\n| Assistive Technology - Adaptive Devices | An item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants. These services directly assist a participant in the selection, acquisition, or use of an assistive technology device. The devices and services must be documented in the individual's Life Plan as being essential to their habilitation, ability to function, or safety, and essential to avoid or delay institutionalization. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Home-Enabling Supports (HES) is a sub-service added to Assistive Technology-Adaptive Devices service effective 10/1/23. Home-Enabling Supports are alternative services, equipment, or supplies which improve and maintain the individual's opportunities for full membership in the community. HES funds items and services that decrease the need for other Medicaid services, promote inclusion in the community, and/or increase the individual's safety and independence in the home environment. Examples of HES may be smart home devices, remote monitoring for the purposes of health and safety, or medical triage services. |\n| Intensive Behavioral Services | Intensive behavioral services are short-term, outcome-oriented, and of higher intensity than other behavioral interventions and are focused on developing effective behavioral management strategies to ensure health and safety and/or improve quality of life. Available under the following circumstances: 1. For individuals who reside in a non-certified residential location, their own home or family home, or a family care home; and 2. The individual or a party acting on behalf of the individual certifies through written documentation that the individual is at risk of imminent placement in a more restrictive living environment due to challenging behavioral episodes. |\n| Environmental Modifications (Home Accessibility) | Physical adaptations to the individual's home, required by the individual's Life Plan, that are necessary to ensure the health, welfare and safety of the individual, or that enable the individual to function with greater independence in the home, and without which the person would require institutionalization and/or more restrictive and expensive living arrangement. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Some modifications may include installation of ramps, hand rails and grab-bars, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies needed for the welfare of the recipient, lifts and related equipment, modifications of the kitchen necessary for the individual to function more independently in his home, strobe light smoke detection and alarm devices. |\n| Vehicle Modifications | Physical adaptations to the individual's primary vehicle, required by the individual's Life Plan, that are necessary to ensure the health, welfare, and safety of the individual or that enable the individual to function with greater independence. These physical adaptations may include portable electric/hydraulic and manual lifts, ramps, and ancillary equipment or modifications necessary to guarantee full access to, and safety in, a motor vehicle. |\n| Family Education and Training | Training given to families of individuals enrolled in the HCBS waiver is intended to enhance the decision-making capacity of the family unit, provide orientation regarding the nature and impact of an intellectual or developmental disability on the individual and their family, including behavioral management practices, and teach the family about service alternatives. The purpose is to support the family unit in understanding and coping with the intellectual or developmental disability and create a supportive environment at home to decrease premature residential placement outside the home. |\n| Community Transition Services | Non-recurring set-up expenses for individuals who are transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence in the community, where the person is directly responsible for his or her own living expenses. Allowable expenses are those reasonable and necessary to enable a person to establish a basic household. Allowable items include security deposits that are required to obtain a lease on an apartment or home, essential household furnishings, set-up fees or deposits for utility or service access, and moving expenses. |\n| Live-in Caregiver | An unrelated care provider who resides in the same household as the individual and provides supports to address the individual's physical, social or emotional needs in order for them to live safely and successfully in their own home. The Live-in Caregiver must be unrelated to the individual by blood or marriage. |\n| Fiscal Intermediary (FI) | The fiscal intermediary supports the individual self-directing their HCBS services with billing and payment of approved goods and services, fiscal accounting and reporting, ensuring Medicaid and corporate compliance, and general administrative supports. |\n| Individual Directed Goods and Services (IDGS) | Services, equipment, or supplies not otherwise provided through this waiver or through the Medicaid State Plan that addresses an identified need in an individual's Life Plan, which includes improving and maintaining the individual's opportunities for full membership in the community. Individuals who choose to self-direct their services with budget authority may receive IDGS as a waiver service. Individuals may manage their IDGS budget, as described in their Life Plan, to fully purchase or put funds towards their personal fiscal resources to purchase items or services which meet the criteria as described in the waiver. |\n| Support Brokerage | Assist individuals (or the individual's family or representative as appropriate) to self-direct and manage some or all of their waiver services. The support broker assists the individual in the day-to- day management of services and provides support and training to the individuals and their family regarding the ongoing decisions and tasks associated with self-direction. |" (source, capture b087a1e5a4f8bf59d300b6dddbd637d102cf93ff68775464326c346dbe26262f)
• /offerings/0/rules: " \nMust reside in NYS For individuals who have Intellectual and/or Developmental Disabilities (I/DD) of any age who are eligible for Office of Persons with Developmental Disabilities (OPWDD) services \n \nEligibility Criteria\n* Have a developmental disability as defined by New York State Mental Hygiene Law Section 1.03 (22) that originated before the age of 22; has continued or can be expected to continue indefinitely; and constitutes as a substantial handicap to such person’s ability to function normally in society\n* Be in a Medicaid eligibility group that is eligible to enroll in Medicaid as described in the OPWDD HCBS Waiver and defined in SSA §§ 1634(c) and 1902(a)(10)(A)(i) and (ii) and 42 CFR Part 435\n* Need a Level of Care that would be provided in an Intermediate Care Facility for Individuals with Intellectual and/or Developmental Disabilities (ICF/IID)\n* Reside in NYS and live in an appropriate living arrangement (and/or be residing in an appropriate living arrangement once enrolled in the HCBS waiver) as per OPWDD's waiver regulations\n* Not be enrolled in another HCBS Waiver or Managed Long-Term Care (MLTC) Plan as described in 42 CFR §433 Subpart D; and\n* Meet the requirement of a Reasonable Indication of Need for Services as defined in 42 CFR §441.302(c) and described in the OPWDD HCBS Waiver\n \nTarget Population \n* The OPWDD Waiver services individuals with an Intellectual Disability or Developmental Disability, or Both \n \nMust reside in NYS\n**Each participant enrolled in the Children's Waiver must receive care management through either a Health Home or Children and Youth Evaluation Service (C-YES). Health Homes provide the following Care Coordination Services:Each participant enrolled in the OPWDD Waiver must receive care coordination through a Care Coordination Organization/Health Home (CCO)/HH provide the following Care Coordination Services:\n_Comprehensive Care Management_ - Assess needs, develop care plan \n \n_Care Coordination and Health Promotion_ - Work with providers \n \n_Comprehensive Transitional Care_ - Discharge planning, help to new programs \n \n_Enrollee and Family Support_ - Assist with appointments and meetings \n \n_Referral to Community and Social Supports_ - Link to Services and Resources, including Children's Waiver HCBS. \n \n_Children/families who opt-out of Health Home but remain enrolled in the Children's Waiver can receive care management through C-YES. C-YES offers a less intensive version of care management and only coordinates HCBS. C-YES does not assist with coordination of other supports/services outside of Children's HCBS._ Comprehensive Care Management - Assess needs, develop care plan \n \n_Care Coordination and Health Promotion_ - Work with providers \n \n_Comprehensive Transitional Care_ - Discharge planning, help to new programs \n \n_Enrollee and Family Support_ - Assist with appointments, and meetings \n \n_Referral to Community and Social Supports_ - Link to Services and Resources\n**Participants who meet eligibility criteria for the Consolidated Children's Waiver maybe able to receive the services below:Participants who meet eligibility criteria for OPWDD Comprehensive Waiver:\n_Community Habilitation \n \nDay Habilitation \n \nPrevocational Services \n \nSupported Employment \n \nPlanned and Crisis Respite \n \nAdaptive and Assistive Technology (AAT) \n \nEnvironmental Modifications)(EMods) \n \nVehicle Modifications (VMods) \n \nCaregiver/Family Advocacy and Support Services \n \n \n \nNon-Medical Transportation \n \nPalliative care - Expressive Therapy \n \nPalliative care – Pain and Symptom Management \n \nPalliative care – Counseling and Support Services \n \nPalliative care – Massage Therapy_ \n \n \nPlease see the Appendix for a description of these services _Community Habilitation \n \nDay Habilitation \n \nPrevocational Services - (Site-Based and Community-Based) \n \nSupported Employment (SEMP) \n \nRespite \n \nAssistive Technology - Adaptive Devices \n \nEnvironmental Modifications (Home Accessibility) \n \nVehicle Modifications \n \nResidential Habilitation \n \nCommunity Transition Services \n \nFiscal Intermediary (FI) \n \nSupport Brokerage \n \nIndividual Directed Goods and Services (IDGS) \n \nLive-in Caregiver \n \nFamily Education and Training \n \nIntensive Behavioral Services \n \nSee Appendix for a description of these service \n \nper ADM 23-ADM-06: Pathway to Employment_\n " (source, capture b087a1e5a4f8bf59d300b6dddbd637d102cf93ff68775464326c346dbe26262f)
• /offerings/0/rules: "| APPENDIX OPWDD Comprehensive Waiver Services |\n| --- |\n| Service | Description |\n| Residential Habilitation | Individually tailored supports that assist with the acquisition, retention or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living (hands-on), community inclusion and relationship building, training and support for independence in travel, transportation, adult educational supports, social skills, leisure skills, self-advocacy and informed choice skills, and appropriate behavior development that assists the participant to reside in the most integrated setting appropriate to his/her needs. Residential Habilitation services are limited to individuals who reside in OPWDD certified residential settings. |\n| Community Habilitation | Services occurring largely in community (non-certified) settings to facilitate and promote independence and community integration. Community habilitation is defined as a face-to-face service and offers skills training and supports including adaptive skill development, assistance with activities of daily living, travel, health, adult educational supports, communication, social skills, leisure skills, money management, socially appropriate behaviors, life safety, self-advocacy, informed choice, community inclusion, and relationship building |\n| Day Habilitation | Day Habilitation services include assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills, including communication, travel, and adult education that regularly takes place in a non-residential setting, separate from the person's private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy, and informed choice. Day habilitation services may also be used to provide supportive retirement activities, including: altering schedules to allow for more rest time throughout the day, support to participate in hobbies, clubs and/or other senior related activities in their communities. A supplemental version of Day Habilitation is available for individuals who do not reside in a certified 24/7 location, including services occurring at night and on the weekend. OPWDD Day Habilitation can be provided on-site or \"without walls\" in the community. |\n| Pathway to Employment | A person-centered, comprehensive career planning and support service that provides assistance for individuals to obtain, maintain, or advance in competitive employment or self-employment. It is a focused, time-limited service that engages a participant in identifying a career direction, provides instruction and training in pre-employment skills, and develops a plan for achieving competitive, integrated employment at or above the state minimum wage. Within 12 months or sooner, the outcome of this service is documentation of the individual's stated career objective; a detailed career plan used to guide individual employment supports; and preparation for supported employment services that assist an individual in obtaining, maintaining, or advancing in competitive employment or self- employment. |\n| Prevocational Services (Site-Based and Community) | Services that provide learning and work experiences, including volunteering, where participants can develop general, non-job task specific strengths and skills that contribute to employability in paid employment in integrated community settings and increase levels of independence. Services are expected to occur over a defined period of time based upon a person-centered planning process. Services include activities that are not primarily directed at teaching skills to perform a particular job, but at underlying habilitative goals (e.g., attention span, motor skills, interpersonal relations with co-workers and supervisors) that are associated with building skills necessary to perform work and optimally to perform competitive, integrated employment. There are two separate types of prevocational services: Site-Based Prevocational Services and Community Prevocational Services. Site-based prevocational services are delivered in OPWDD certified non-residential facilities. Community prevocational services are provided primarily in community settings. |\n| Supported Employment (SEMP) | Ongoing support to participants who need continuous support to obtain and maintain a job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce for which an individual is compensated at or above the state minimum wage. The outcome of this service is paid employment at or above the state minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals; as such, career planning is also an allowable service activity. Supported employment services may include any combination of the following services: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching, benefits support, training and planning, transportation, asset development and career advancement services, and other workplace support services including services not specifically related to job skill training that enable the individual to be successful in integrating into the job setting. |\n| Respite | Services provided to participants unable to care for themselves that are furnished on a short-term basis because of the absence of or need for relief of those persons who normally provide care for the participant. Respite care is not furnished or provided for the purpose of compensating relief or substitute staff in certified community residences. |\n| Assistive Technology - Adaptive Devices | An item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of participants. These services directly assist a participant in the selection, acquisition, or use of an assistive technology device. The devices and services must be documented in the individual's Life Plan as being essential to their habilitation, ability to function, or safety, and essential to avoid or delay institutionalization. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Home-Enabling Supports (HES) is a sub-service added to Assistive Technology-Adaptive Devices service effective 10/1/23. Home-Enabling Supports are alternative services, equipment, or supplies which improve and maintain the individual's opportunities for full membership in the community. HES funds items and services that decrease the need for other Medicaid services, promote inclusion in the community, and/or increase the individual's safety and independence in the home environment. Examples of HES may be smart home devices, remote monitoring for the purposes of health and safety, or medical triage services. |\n| Intensive Behavioral Services | Intensive behavioral services are short-term, outcome-oriented, and of higher intensity than other behavioral interventions and are focused on developing effective behavioral management strategies to ensure health and safety and/or improve quality of life. Available under the following circumstances: 1. For individuals who reside in a non-certified residential location, their own home or family home, or a family care home; and 2. The individual or a party acting on behalf of the individual certifies through written documentation that the individual is at risk of imminent placement in a more restrictive living environment due to challenging behavioral episodes. |\n| Environmental Modifications (Home Accessibility) | Physical adaptations to the individual's home, required by the individual's Life Plan, that are necessary to ensure the health, welfare and safety of the individual, or that enable the individual to function with greater independence in the home, and without which the person would require institutionalization and/or more restrictive and expensive living arrangement. Only those services not reimbursable under a Medicaid State Plan option will be reimbursable under the waiver authority. Some modifications may include installation of ramps, hand rails and grab-bars, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies needed for the welfare of the recipient, lifts and related equipment, modifications of the kitchen necessary for the individual to function more independently in his home, strobe light smoke detection and alarm devices. |\n| Vehicle Modifications | Physical adaptations to the individual's primary vehicle, required by the individual's Life Plan, that are necessary to ensure the health, welfare, and safety of the individual or that enable the individual to function with greater independence. These physical adaptations may include portable electric/hydraulic and manual lifts, ramps, and ancillary equipment or modifications necessary to guarantee full access to, and safety in, a motor vehicle. |\n| Family Education and Training | Training given to families of individuals enrolled in the HCBS waiver is intended to enhance the decision-making capacity of the family unit, provide orientation regarding the nature and impact of an intellectual or developmental disability on the individual and their family, including behavioral management practices, and teach the family about service alternatives. The purpose is to support the family unit in understanding and coping with the intellectual or developmental disability and create a supportive environment at home to decrease premature residential placement outside the home. |\n| Community Transition Services | Non-recurring set-up expenses for individuals who are transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence in the community, where the person is directly responsible for his or her own living expenses. Allowable expenses are those reasonable and necessary to enable a person to establish a basic household. Allowable items include security deposits that are required to obtain a lease on an apartment or home, essential household furnishings, set-up fees or deposits for utility or service access, and moving expenses. |\n| Live-in Caregiver | An unrelated care provider who resides in the same household as the individual and provides supports to address the individual's physical, social or emotional needs in order for them to live safely and successfully in their own home. The Live-in Caregiver must be unrelated to the individual by blood or marriage. |\n| Fiscal Intermediary (FI) | The fiscal intermediary supports the individual self-directing their HCBS services with billing and payment of approved goods and services, fiscal accounting and reporting, ensuring Medicaid and corporate compliance, and general administrative supports. |\n| Individual Directed Goods and Services (IDGS) | Services, equipment, or supplies not otherwise provided through this waiver or through the Medicaid State Plan that addresses an identified need in an individual's Life Plan, which includes improving and maintaining the individual's opportunities for full membership in the community. Individuals who choose to self-direct their services with budget authority may receive IDGS as a waiver service. Individuals may manage their IDGS budget, as described in their Life Plan, to fully purchase or put funds towards their personal fiscal resources to purchase items or services which meet the criteria as described in the waiver. |\n| Support Brokerage | Assist individuals (or the individual's family or representative as appropriate) to self-direct and manage some or all of their waiver services. The support broker assists the individual in the day-to- day management of services and provides support and training to the individuals and their family regarding the ongoing decisions and tasks associated with self-direction. |" (source, capture b087a1e5a4f8bf59d300b6dddbd637d102cf93ff68775464326c346dbe26262f)
• /offerings/0/rules: "At the time of enrollment, you must live at home or in a certified Family Care home, community residence or group home." (source, capture d94dcaa93e28c813d56e5a22323d4711a8054f8a4aa0ba5fff10a676b6768a1f)
• /offerings/0/access/0/how: "To receive the supports and services offered through the HCBS Waiver, you will need to enroll in the program.To request enrollment, you must fill out and submit an Application for Participation." (source, capture d94dcaa93e28c813d56e5a22323d4711a8054f8a4aa0ba5fff10a676b6768a1f)