Updated Release of the Children's SPA/HCBS Provider Designation Application

The New York State (NYS) agencies including the Department of Health (DOH), Office of Alcoholism and Substance Abuse Services (OASAS), Office of Children and Family Services (OCFS), Office of Mental Health (OMH), and the Office for People With Developmental Disabilities (OPWDD) are pleased to announce the re-release of the Children´s State Plan (SPA)/Home and Community Based Services (HCBS) Provider Designation Application. The designation application is available at:

Purpose of Provider Designation
Beginning July 1, 2018, providers must be designated through this process to provide newly aligned Children’s SPA/HCBS services under the NYS Medicaid program (both fee-for-service Medicaid and Medicaid Managed Care):
SPA: Other Licensed Practitioner, Crisis Intervention, Community Psychiatric Supports and Treatment, Psychosocial Rehabilitation, Family Peer Support Services, Youth Peer Support and Training.

HCBS: Caregiver Family Supports and Services, Crisis Respite, Habilitative Skill Building, Planned Respite, Supported Employment, Community Self-Advocacy Training and Support, Habilitation, Palliative Care, Prevocational Services


  • State Agency Partners will prioritize reviews of applications from current 1915(c) waiver providers beginning in July 2017.
  • NYS anticipates sending out designation letters to current system providers in October, 2017.
  • Lists of designated providers will be posted online. This list will be utilized by Medicaid Managed Care Plans to develop networks for service provision that begins on July 1, 2018.
  • The application was revised on June 14, 2017 to include additional questions

**For applications that were submitted prior to the June 14, 2017 modification date, resubmission is not necessary an e-mail notification will be sent by NYS requesting additional information.

Note: NYS advises current system providers to submit designation applications by Monday, July 31, 2017. Contracting, credentialing, and claims testing typically take approximately nine months in total. Delays in submission of the application to NYS may result in delay dependent contracting, credentialing, and claims testing work, and could affect network status on July 1, 2018.

What You Need Before Completing the Application
This application requires providers to have:

  • A user ID (granted by the NYS OMH)
  • A Facility Code

Instructions on obtaining these credentials are available at

NYS DOH submitted an amendment to the 1115 New York Medicaid Redesign Waiver to the Centers for Medicare and Medicaid Services (CMS) to implement the Children’s Behavioral Health and Health Medicaid Redesign. The proposed Amendment includes the following implementation dates for key elements of the Children’s Redesign.