Home-Enabling Supports NY

For care managers

HES for CCO Care Managers

Eligibility screening, Life Plan goal phrasing, and the pre-submission checks that keep an HES authorization moving.

Care Managers are the on-ramp for every HES referral in New York — there is no family-facing form. This guide collects the screening, goal-phrasing, and submission details in one place.

What you'll find here

  • The 2-minute referral screener for triaging people on your caseload.
  • Goal-phrasing patterns that align with HES's independence lens.
  • A pre-submission pitfalls checklist — the errors that stall authorizations.
  • Where to compare the designated HES providers in each region.

Goal-phrasing patterns

Life Plan goal language that maps to HES sub-services

HES dollars must align with a Life Plan goal. These examples fit the program's independence lens and translate cleanly at RSA review.

  • Goal: Reduce nighttime safety risk so the person can sleep without a live-in staff person.

    Likely HES fit: Assistive Technology + Remote Supports (overnight monitoring).

  • Goal: Increase medication adherence to maintain stable physical and behavioral health.

    Likely HES fit: Assistive Technology (smart medication dispenser).

  • Goal: Reduce avoidable ER visits during after-hours health changes.

    Likely HES fit: HACS (24/7 I/DD-trained telemedicine).

  • Goal: Support independent transportation to a day program with verified safe arrival.

    Likely HES fit: Assistive Technology (wearable with GPS) + Remote Supports (Active On-Demand).

GPS-based options are a rights restriction (14 NYCRR 633.4 / 636-2.4) — written informed consent comes first. Privacy & consent rules.

Before you submit

Pre-submission pitfalls

Four checks worth running before the RSA goes to the DDRFO.

  • No reimbursement before the NOD

    Expenses incurred before the DDRFO issues prior authorization are not reimbursable. Nothing gets bought until the Notice of Decision is in hand.

  • Check which waiver

    HES requires OPWDD HCBS Waiver enrollment. The Children's HCBS Waiver and DOH's TBI waiver are excluded.

  • The "supportive" trap

    A Supportive IRA is a certified residence — not HES-eligible until the person moves out. "Supportive Housing" or a supportive apartment is non-certified and eligible. Same word, opposite certification status.

  • Transitions: plan the referral ahead of the move

    A person leaving a certified setting becomes HES-eligible once they are officially out — HES can't start while they are still in a certified home. Work with the person's provider and an HES vendor to prepare the referral ahead of the move so it is ready once the transition completes. Other technology can also help ease the move itself outside HES — worth raising with the provider or a vendor.

The setting rules in full, including the Supportive-IRA edge case: eligibility deep-dive.

Resources

How the process works

Step-by-step with the right form names and decision points.

Eligibility (setting + transition intent)

The non-certified rule, the Supportive-IRA edge case, and the age-15+ limit on Remote Supports.

How the designated providers work

What HES providers do and how to compare the ones serving your region.

Provider directory by region

Every designated HES provider by OPWDD region, with contact information where verified.

Frequently asked

RSA or SART?
In practice, a Request for Service Authorization (RSA) opens a new HES authorization and a Service Amendment Request Tool (SART) amends an existing one. ADM 2024-02 names both forms without a firm when-to-use rule, so confirm the right form with your DDRFO.
Can the person change HES providers?
The ADM doesn't spell out a provider-change procedure. In practice it runs through a service amendment with your DDRFO. Confirm the required form — and whether the new provider re-assesses — before promising a timeline.
Can a person have HES alongside other waiver services?
Yes — and HES alone is not enough. It does not satisfy the "reasonable indication of need" requirement for ongoing waiver enrollment. The person must also receive at least one monthly HCBS waiver service or monthly health-and-safety monitoring — care management counts (42 CFR §441.302(c); ADM 2023-06).

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