(HCBS) Services Application - Office of Mental Health - New York State 2025

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  1. Click ‘Get Form’ to open the HCBS Services Application in our editor.
  2. Begin by entering your child's name and date at the top of the form. This personalizes the application and ensures it is correctly attributed.
  3. Review the eligibility criteria section carefully. Check off any applicable boxes that indicate whether your child meets the clinical eligibility requirements for HCBS waiver services.
  4. If your child does not meet eligibility, provide detailed reasons in the designated fields. Be thorough, as this information is crucial for any potential redetermination.
  5. Complete the contact information section at the bottom of the form, ensuring all details are accurate for follow-up communication from the ICC agency.
  6. Once all sections are filled out, utilize our platform’s signing feature to electronically sign and date the application before submission.

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NYS Behavioral Health Home and Community Based Services (BH HCBS) BH HCBS will be available to adults meeting Serious Mental Illness (SMI) and Substance Use Disorder (SUD) criteria and risk factors who are enrolled in the HARP and found eligible through an assessment.
Get help from 111 online or call 111 and select the mental health option.
The organization applying for HCBS Provider designation through the non-licensed/designated/certified provider process must have at least 5 years of experience as an agency serving high needs children, including children who are medically complex/fragile, have developmental disabilities, have diagnosed behavioral
The New York State Office of Mental Health (OMH) oversees a large multi-faceted mental health system serving nearly 800,000 individuals each year. This includes operating 23 psychiatric centers and overseeing the Nathan S. Kline Institute and New York Psychiatric Institute.
Phone. 1-800-663-6114 - Complaints/Inquiries (Monday-Friday 9:00 a.m - 5:00 p.m.)

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For questions about mental health services, to find a mental health service provider or to make a complaint, call OMH Customer Relations toll-free at 1-800-597-8481.
The Medicaid Managed Care service system includes several behavioral health services, such as Health and Recovery Plans (HARPs). HARPs provide a variety of services for adults 21 and older who have serious mental illness and substance use disorders.
The four major forms of mental health care services are delivered in psychiatric hospitals, residential treatment, outpatient care, and dual diagnosis settings.

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