July 2025 Top of Mind

Updated guidelines required for new HCBS referrals and authorizations​

New York State behavioral health providers are now operating under updated guidelines for the Children’s Waiver Home- and Community-Based Services (HCBS) Service Definition and Necessity Criteria Policy effective June 1, 2025. The revised policy consolidates and clarifies existing requirements, superseding previous guidance and webinars. HCBS community-based services help prevent the need for institutional care, when appropriate.

The policy update standardizes service delivery and ensures that care aligns with member unique needs, preferences, and goals, fostering holistic well-being and empowering their families/caregivers.

The new guidelines provide updated service definitions, allowable components and necessity criteria designed to enhance consistency and quality in HCBS planning and provision. Key highlights include:

• Effective date: Applies to all new referrals and service authorizations on or after June 1, 2025.
• Service plan updates: Changes to existing HCBS authorizations are not required, but new HCBS referrals and authorization requests must conform to this updated policy.
• Provider responsibilities: Health Home Care Managers, Children and Youth Evaluation Services, HCBS providers, and Medicaid managed care plans must comply with the new policy.
• Policy structure: All services and service-specific criteria are divided into general requirements, including definitions, modalities, settings, limitations and provider qualifications.

Take a closer look

The New York State Department of Health also updated the Children’s Home and Community Based Services Manual to align with the new policy. You can review the full policy document on their website.