1. Program Definition and Services 

Service Coordination Services in New York provide short-term and ongoing case management support to children and adults with disabilities, chronic conditions, or complex health needs. The program aims to help maintain individuals in the community, averting the need for long-term institutional services and supports. Services include:

• In-Home/Community Assessment and Care Planning: Individualized person-centered care planning, continuous service monitoring, resource linkage, and face-to-face client advocacy provided directly within the individual/family home to promote independence.
• Residential and Crisis Transition Tracking: Supervision of multi-provider healthcare networks, centralized resource scheduling, and coordinated crisis intervention tracking originating from licensed residential or community-based settings.

2. Regulations 

The program is governed by the following regulations: New York Codes, Rules and Regulations, Title 14, Part 635 (Rule 635)

• New York Codes, Rules and Regulations, Title 14, Part 636 (Person-Centered Planning Standards)
• Mental Hygiene Law (MHL Articles 16 & 33)
• Social Services Law (Protection of People with Special Needs)
• Child Protective Services Act (State Central Register Reporting)

3. Licensing or Certification 

Providers must be certified by the New York State Department of Health (NYSDOH) or partner state agencies, obtain appropriate Care Coordination Organization (CCO) or Health Home designations where applicable, and strictly follow all Home and Community-Based Services (HCBS) conflict-free case management requirements.

4. Responsible State Agency 

The New York State Department of Health (NYSDOH), working in tandem with the Office for People With Developmental Disabilities (OPWDD) and the New York State Office of Mental Health (OMH), is responsible for reviewing applications and certifying service coordination services providers.

5. Application Process 

The application process is conducted through the electronic New York Medicaid Provider Enrollment Portal (eMedNY). Providers must submit specialized provider enrollment forms online to initiate the application process.

6. Required Documentation 

While specific documentation requirements vary based on the target waiver, providers typically need to submit: 

• Proof of compliance with federal conflict-free care management and state operational rules 
• Agency policies and procedures (including person-centered intake, crisis response, and data sharing protocols) 
• Staff qualifications, human services degrees, background clearances, and training records
• Proof of professional liability insurance, general liability insurance, and cybersecurity/data privacy insurance

7. Timeline for Approval 

The exact timeline for approval fluctuates based on agency capacity and specific waiver designation loops. Providers should contact their regional office for detailed information on current processing timeframes.

8. Pre-Application 

Process Prospective providers must complete specific foundation tasks before applying. They must establish their business entity with the New York Department of State and secure necessary federal identification numbers (EIN and NPI Type 2).

9. Pre-Application Training 

The state hosts mandatory administrative, person-centered planning, and waiver compliance training sessions online. Access details are sent to qualified applicants once preliminary paperwork is reviewed.

10. Additional Notes 

• Providers must ensure that data tracking systems and administrative offices meet all state accessibility (ADA), HIPAA data encryption, and environmental safety guidelines 
• In-Home Service Coordination and Advocacy must be provided directly by the certified agency's employed personnel and approved case managers 
• All direct care coordinators, supervisors, and administrative directors must conduct mandatory background clearances, Office of the Medicaid Inspector General (OMIG) screening, and fingerprinting checks
• Providers must maintain detailed records of face-to-face service encounters, integrated Life Plans, and monthly coordination tracking logs for Medicaid documentation and billing

Why Choose Waiver Consulting Group? 

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state. 

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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