Children's
Services

Children’s services encompass all physical and behavioral health services and include both primary and specialty care.  Children can access services for preventative, urgent and emergent care.  For quick reference about plan benefits, consult our plan benefit guide here.

Beginning in January 2019, based on State changes, Amida Care began covering additional physical and behavioral health services and populations that were previously excluded from Managed Medicaid.

Children and Family Treatment and Support Services (CFTSS)

As of 1/1/2019, three Children and Family Treatment and Support Services became available for Medicaid recipients under age 21:

Smiling Father and Child

  1. OLP- Other Licensed Practitioner
  2. CPST- Community Psychiatric Supports and Treatment
  3. PSR- Psychosocial Rehabilitation

As of 7/1/2019, 1 additional CFTSS became available for Medicaid recipients under age 21:

  1. FPSS- Family Peer Support Services

Additional CFTSS services became available as of January 2020:

  1. Youth Peer Support and Training
  2. Crisis Intervention

More information about CFTSS can be accessed below:

English: https://www.omh.ny.gov/omhweb/bho/docs/cftss_brochure_english.pdf
Spanish: https://www.omh.ny.gov/omhweb/bho/childrensmc/cftss_spanish.pdf

Home and Community Based Services for Children (HCBS) & C-YES

As of October 1, 2019, Home and Community Based Services are covered for Medicaid recipients under age 21 if determined they are HCBS eligible by a Health Home or through the Children and Youth Evaluation Service (C-YES).

Smiling Children

  1. Community Habilitation
  2. Day Habilitation
  3. Caregiver/Family Support and Services
  4. Community Self Advocacy Training Support
  5. Prevocational Services
  6. Supported Employment
  7. Respite Services
  8. Palliative Care:
    • Palliative Care Pain and Symptom Management
    • Palliative Care Bereavement Counseling
    • Palliative Care Massage Therapy
    • Palliative Care Expressive Therapy- (i.e. art, music and play)
  9. Environmental Modifications (EMOD)
  10. Vehicle Modifications (VMOD)
  11. Adaptive and Assistive Technology (AT)
  12. Non-Medical Transportation

More information about HCBS can be accessed below:

English: https://www.omh.ny.gov/omhweb/bho/docs/hcbs_brochure_english.pdf
Spanish: https://www.omh.ny.gov/omhweb/bho/childrensmc/hcbs_brochure_spanish.pdf

Children’s Health Home Care Management and Children and Youth Evaluation Service (C-YES) are two separate sources of Home and Community-Based Services (HCBS). C-YES provides care coordination for participants who are not enrolled in a Medicaid Managed Care Plan, so if you are a member of Amida Care responsible for someone under the age of 21 who is not enrolled in a Medicaid Managed Care Plan, C-YES is an excellent option. Amida Care members responsible for someone under the age of 21 who is enrolled in a Medicaid Managed Care Plan should explore Health Home Care Management.

More information about Children’s Health Home Care Management and Children and Youth Evaluation Service (C-YES) HCBS can be accessed below:

English: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/children_hcbs_care_management_brochure.pdf

Foster Care Services

Voluntary Foster Care Agency (VFCA) services have been transitioned from fee-for-service (FFS) Medicaid to Medicaid Managed Care plans like Amida Care. The following services related to foster care take effect on July 1, 2021:

Child Sitting Outdoors

  • Public Health Law Article 29-I Licensure becomes effective for VFCAs;
  • Core Limited Health Related Services and Other Limited Health Related Services provided by Article 29-I VFCAs are added to the Medicaid Managed Care Benefit Package; and
  • Children/youth placed in foster care with a VFCA are no longer excluded from enrollment in Medicaid managed care.

Amida Care members who are living in a foster care residence or home can access various 29-I facility services. If you have any questions about foster care services, please call Amida Care and ask to speak to the Children’s Services Unit. If you are seeking advocacy related to foster care services, please visit:

29-I Health Facility services for Amida Care members eligible to be served by a 29-I Health Facility, include:

Medically necessary Other Limited Health-Related Services (OLHRS) that the 29-I Health Facility is authorized by the State to provide may include:

Children and Family Treatment Supports and Services (CFTSS)
  • Other Licensed Practitioners (OLP)
  • Community Psychiatric Supports and Treatment (CPST)
  • Psychosocial Rehabilitation (PSR)
  • Family Peer Supports and Services (FPSS)
  • Youth Peer Support and Training (YPST)
  • Crisis Intervention (CI)


Children’s Waiver HCBS
  • Caregiver Family Supports and Services
  • Community Advocacy and Support
  • Respite (Planned and Crisis)
  • Prevocational Services
  • Supported Employment
  • Day Habilitation
  • Community Habilitation
  • Palliative Care: Bereavement Therapy
  • Palliative Care: Expressive Therapy
  • Palliative Care: Massage Therapy
  • Palliative Care: Pain and Symptom Management
  • Environmental Modifications
  • Vehicle Modifications
  • Adaptive and Assistive Equipment
  • Non-Medical Transportation


Medicaid State Plan services

Screening, diagnosis and treatment services related to physical health, including but not limited to:

  • Ongoing treatment of chronic conditions as specified in treatment plans
  • Diagnosis and treatment related to episodic care for minor ailments, illness or injuries, including sick visits
  • Primary pediatric/adolescent care
  • Immunizations in accordance with NYS or NYC recommended childhood immunization schedule
  • Reproductive health care

Screening, diagnosis and treatment services related to developmental and behavioral health. This includes the following:

  • Psychiatric consultation, assessment, and treatment
  • Psychotropic medication treatment
  • Developmental screening, testing, and treatment
  • Psychological screening, testing and treatment
  • Smoking/tobacco cessation treatment
  • Alcohol and/or drug screening and intervention
  • Laboratory tests


Applied Behavior Analysis (ABA)

Effective October 1, 2021, Applied Behavior Analysis (ABA) services provided by a Licensed Behavior Analyst (LBA) and a Certified Behavior Analyst Assistant (CBAA) working under the supervision of LBAs, or other individuals specified under Article 167 of NYS education law, will be included in the Medicaid managed care (MMC) benefit package. This expansion allows for ABA providers to provide services to people under the age of 21 who are on Medicaid Managed Care Plans, like the Special Needs Plan (SNP) Amida Care.

ABA is a type of intervention focusing on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. Broadly, ABA is the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.

Amida Care members may be eligible for ABA if they are under age 21 and have received a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The enrollee must be referred by a NYS licensed and NYS Medicaid enrolled physician (including psychiatrists and developmental/behavioral pediatricians), psychologists, psychiatric nurse practitioners, pediatric nurse practitioners, or physician assistants.

 

Additional information and related resources for children, adults, and their families can be found on our website under the For Members section in Health Resources page.

X