New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities
Subpart 635-12 - Liability for Services
Section 635-12.12 - Limited exception for supported employment services and respite services
Universal Citation: 14 NY Comp Codes Rules and Regs § 635-12.12
Current through Register Vol. 47, No. 12, March 26, 2025
Prior to July 1, 2015, the limited exception provisions in this section were applicable to individuals applying for supported employment services who met specified criteria. The limited exception is no longer permitted for individuals enrolling in supported employment services on and after July 1, 2015.
(a) The provisions of sections 635-12.2 --635-12.10 of this Subpart are not applicable in the circumstances in either paragraph (1) or paragraph (2) of this subdivision:
(1)
Supported employment services. The individual is enrolled in supported
employment services and all of the following conditions are met:
(i) either:
(a) the individual was enrolled in supported
employment services prior to July 1, 2015, and was continuously enrolled in
supported employment services with the same provider on and after July 1, 2015;
or
(b) the individual was enrolled
in supported employment services prior to July 1, 2015, and on or after July 1,
2015 the provider downsized or eliminated the provision of supported employment
services, causing the individual to dis-enroll in that provider's supported
employment services and re-enroll in supported employment services from the
same or a different provider.
(ii) the individual is not enrolled in any of
the following services:
(a) Medicaid Service
Coordination;
(b) day treatment
services;
(c) residential
habilitation provided in an individualized residential alternative (IRA),
community residence (CR), or family care home;
(d) hourly community habilitation;
(e) day habilitation services;
(f) site based prevocational
services;
(g) community
prevocational services;
(h) respite
services.
Note:
This list of services previously included at-home residential habilitation, community habilitation phase II, and blended and comprehensive services, which have been discontinued.
(iii) the individual was not
enrolled in the HCBS Waiver at any time on or after March 15,
2010.
(2) Respite
services. The individual is applying for or enrolled in respite services and
all of the following conditions are met:
(i)
The individual is not enrolled in any of the following services:
(a) Medicaid Service Coordination;
(b) day treatment services;
(c) residential habilitation provided in an
IRA, CR, or family care home;
(d)
hourly community habilitation;
(e)
day habilitation services;
(f) site
based prevocational services;
(g)
community prevocational services;
(h) supported employment services.
Note:
This list of services previously included at-home residential habilitation, community habilitation phase II, and blended and comprehensive services, which have been discontinued.
(ii) The individual was not
enrolled in the HCBS Waiver at any time on or after March 15,
2010.
(b) Notice requirements. All notices specified in this subdivision shall be in the form and format specified by OPWDD.
(1)
Respite. Providers of respite services shall notify all individuals applying
for respite services, who appear to meet the requirements for the limited
exception set forth in paragraph (a)(2) of this section, about the limited
exception and the obligation of the individual to notify the provider if he or
she applies for other services.
(2)
Supported employment services. Providers shall notify all individuals who are
qualified for the limited exception on July 1, 2015 about the changes in
criteria for qualification for the limited exception for supported employment.
The notice must be provided to all such individuals no later than August 1,
2015.
(c) Supported employment services--individuals applying for other services.
(1) If an individual enrolled in supported
employment services meets the criteria specified in paragraph (a)(1) of this
section, and applies for another service specified in such paragraph, the
individual and the provider of other services receiving the application must
notify the provider of the supported employment services that such application
has been made.
(2) Prior to the
receipt of the other services, the provider of the other services and the
provider of supported employment services (if the provider of supported
employment services is aware of the individual's application for another
service) shall give notice to the individual and liable parties, if known. The
notice shall be in the form and format specified by OPWDD and shall include
information about the following:
(i) that the
limited exception will no longer be in effect if the person who is enrolled in
supported employment services enrolls in any of the other services;
(ii) the provisions of clause
(a)(1)(i)(b) of this section concerning individuals who were
enrolled in supported employment prior to July 1, 2015 and who switch providers
of supported employment on or after July 1, 2015; and
(iii) information about the obligations of
the individual and liable parties when the individual enrolls in other services
and potential consequences of failure to comply with such
obligations.
(3) If the
individual enrolls in any of the other services in addition to the supported
employment services, the limited exception is no longer in effect and the
provisions of sections
635-12.2 --635-12.10 of this
Subpart are applicable, effective on the date the person begins to receive the
other services.
(4) The obligations
of the individual and liable parties to pay for the supported employment
services as specified in section 635-12.6 or
635-12.7 of this Subpart starts on
the date the person enrolls in the other services or, if the supported
employment services are preexisting services, on June 15, 2010 (if it is
later).
(5) An individual who was
enrolled in supported employment services prior to July 1, 2015, who is also
enrolled in any of the other services specified in paragraph (a)(1) or (2) of
this section may stop receiving the other service(s). If all of the criteria
specified in paragraph (a)(1) or (2) of this section are met, the provisions of
sections 635-12.2 through
635-12.10 of this Subpart will no
longer be applicable, effective the date the person dis-enrolls from all such
other services. This does not apply to individuals who enroll in supported
employment services on or after July 1, 2015. These individuals are not
eligible for the limited exception described in this section.
(d) Respite services--individuals applying for other services.
(1) If an
individual is applying for or enrolled in respite services, meets or is
expected to meet the criteria specified in paragraph (a)(2) of this section,
and applies for another service specified in such paragraph, the individual and
the provider of other services receiving the application must notify the
provider of the respite services that such application has been made.
(2) Prior to the receipt of the other
services, the provider of the other services and the provider of respite
services (if the provider of respite services is aware of the individual's
application for another service) shall give notice to the individual and liable
parties, if known. the notice shall be in the form and format specified by
OPWDD, and shall include information that the limited exception will no longer
be in effect if the person who is enrolled in respite services enrolls in any
of the other services, and information about the obligations of the person and
liable parties that would then be required and potential consequences of
failure to comply.
(3) If the
individual enrolls in any of the other services in addition to the respite
services, the limited exception is no longer in effect and the provisions of
sections 635-10.2 --635-10.10 of this
Subpart are applicable, effective on the date the person begins to receive the
other services.
(4) The obligations
of the individual and liable parties to pay for the respite services as
specified in section 635-12.6 or
635-12.7 of this Subpart starts on
the date the person enrolls in the other services or, if the respite services
are preexisting services, on June 15, 2010 (if it is later).
(5) An individual enrolled in respite
services who is also enrolled in any of the other services specified in
paragraph (a)(1) or (2) of this section, as applicable, may stop receiving the
other service(s). If all of the criteria specified in paragraph (a)(1) or (2)
of this section are met, the provisions of sections
635-12.2 --635-12.10 of this
Subpart will no longer be applicable, effective the date the person dis-enrolls
from all such other specified services.
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