Home and Community Based Alternatives (HCBA) Waiver Program

San Ysidro Health (Waiver Agency) has been assigned by the Department of Health Care Services (DHCS) to provide administrative services and Comprehensive Care Management services, under the Medi-Cal HCBA Waiver Program to San Diego County participants.

‍If you qualify:

• You keep your Primary Medical Doctor (PCP) / Provider.
• You keep your IHSS services and provider(s).
• The HCBA waiver offers additional care to assist you in your medical care at home.

How to contact us:

Toll free number: 1-833-503-5910 or e-mail: caremanagement@syhealth.org

DHCS Letter regarding HCBA Waiver Enrollment Pause

‍What is HCBA Waiver Program?

The HCBA Waiver (formerly the Nursing Facility/Acute Hospital (NF/AH) Waiver) was approved by the Centers for Medicare and Medicaid Services (CMS) on May 16, 2017.  Medicaid’s Home and Community-Based Services (HCBS) Waiver programs, including the HCBA Waiver, are authorized under Section 1915(c) of the Social Security Act; governed by Title 42, Code of Federal Regulations (CFR); and administered by CMS.

The Home and Community-Based Waiver program offers Medi-Cal services to a limited number of people with disabilities and/or chronic health conditions to help them live at home instead of in a nursing facility or other Medi-Cal funded institution. Individuals are eligible as long as they qualify for admission to:

• a nursing facility (including an intermediate care facility),
• a subacute facility, or an acute care hospital.

The purpose of the Home and Community-Based Alternatives (HCBA) Waiver, also referred to as the “Waiver,” is to provide Medi-Cal members with long-term medical conditions who meet one of the designated LOC, the option of returning to and/or remaining in a home or home-like community setting in lieu of institutionalization.

The Home and Community Based Alternatives Waiver provides care management services to persons at risk for nursing home or institutional placement. The care management services are provided by a multidisciplinary care team comprised of a nurse and social worker. The care management team coordinates Waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other available long-term services and supports available in the local community. Care management and Waiver services are provided in the Participant’s community-based residence. This residence can be privately owned, secured through a tenant lease arrangement, or the residence of a Participant’s family member.

How do patients qualify to be on the HCBA Waiver?

This Waiver Program will serve disabled Medi-Cal members, who would, in the absence of this Waiver, and as a matter of medical necessity, pursuant to Welfare & Institutions (W&I) Code §14059, otherwise require care in a health care facility providing the following types of care:

• Acute Hospital,
• Subacute or
• NF A/B Level of Care.

Once the patient has been deemed eligible for HCBA Waiver enrollment, the Care Management Team will assess the HCBA application and determine if the patient meets priority enrollment or if the patient needs to be placed on a waiting list. Our dedicated team is working diligently to expedite all applications.

The HCBA Waiver reserves slots for Medi-Cal eligible individuals for priority enrollment, who have already qualified for the HCBA Waiver program and meet at least one of the following levels of care:

1. Have been residing in a facility for more than 60 days and can be transitioned to a home or home-like setting in the community by connecting them with services and support they require to keep them in a community setting of their choice.
2. Are Medi-Cal members transitioning from other HCBS programs due to their skilled care needs and LOC no longer being met through those programs.
3. Are under the age of 21 years, with or without Medi-Cal eligibility, who meet all of the following criteria.

If you meet criteria for enrollment in the HCBA Waiver program but don’t qualify for priority enrollment, you will be added to the waiting list.

If you are interested to apply in the HCBA Waiver, please complete our HCBA Waiver application:

HCBA WAIVER APPLICATION (ENGLISH)

HCBA WAIVER APPLICATION (SPANISH)

*READ BEFORE ENROLLING*

Once you completely fill out the application, please download and email the completed application to:  caremanagement@syhealth.org

‍What does the HCBA Waiver Do?

The HCBA Waiver allows Medi-Cal beneficiaries with high- level care needs to continue to live at home or in the community by identifying and ensuring applicants receive services that will sustain their health care needs and safety outside of an institution. Some of the services that may be provided to support Waiver participants in the community include but are not limited to:

• Habilitation Services
• Waiver Personal Care Services (WPCS)
• Community Transitions Services
• Continuous Nursing and Supportive Services
• Developmentally Disabled/Continuous Nursing Care, Non-Ventilator Dependent Services
• Developmentally Disabled/Continuous Nursing Care, Ventilator Dependent Services
• Family/Caregiver Training
• Personal Emergency Response Installation and Testing
• Personal Emergency Response System
• Private Duty Nursing
• Transitional Case Management

Information for HCBA Waiver Participants:

• If you have any questions, concerns, and/or need to reach your Case Manager, please contact us toll free at 1-833-503-5910 or send an email at caremanagement@syhealth.org
• If you need to add a new Waiver Personal Care Services (WPCS) provider please fill out the below form and send:

Via email: Tarsubmission@syhealth.ORG

Via Fax:  (619) 205-6323

Via mail:  1800 Maxwell Rd Chula Vista 91911

WPCS Waiver Service Provider Agreement Form

Once you completely fill out the application, please download and email to: caremanagement@syhealth.org

• It typically takes 7-10 business days for the DHCS WPCS Unit to process the WPCS provider request once the form (correctly completed) has been received by San Ysidro Health.
• Once the DHCS WPCS Unit has set up the new WPCS provider in the system, time sheets will be mailed out.
• If you have any questions regarding payroll and/or time sheets you can reach the DHCS WPCS Unit at:

-Paper Time Cards: (916) 552-9105 Option 4, then Option 2

-Electronic Time Cards: (866) 376-7066 Option 4

Visit the website for the Electronic time sheets: https://www.etimesheets.ihss.ca.gov/login

If you have more question about Waiver Personal Care services, please review the FAQ from DHCS.

WPCS participants and providers can call the WPCS Hotline 916-552-9214.​

• If you are looking for a nursing or WPCS provider, please review the following attachments for the HCBA Waiver Provider lists:

Home Health Agencies (HHAs)  /  Independent Nursing Providers (INPs) 

Personal Care Agencies (PCAs)  /  Congregate Living Health Facilities

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Information for Providers (Home Health Agencies, Personal Care Agencies and/or Independent Nurse Providers):

E-TARS are not allowed at this time for this program. Providers can submit TARs using paper TAR form 50-1 and 50-2 along with supporting documentation in the following manner: Mail, e-fax, or manual fax. San Ysidro Health has 30 days to adjudicate the TARS, however, our goal is to have a 15-day-or-less turnaround time.

All providers in San Diego County must enter into a contract with San Ysidro Health to continue providing care for waiver members under this program. If you have not received a provider contract packet, please contact us or if you have not submitted your contract please do so immediately at Tarsubmission@syhealth.org.

Please send the HCBA Waiver TARs to:

• Via email: Tarsubmission@syhealth.ORG
• Via Fax: 619-205-6323
• Via mail: 1800 Maxwell Rd Chula Vista 91911

Home Health Agencies will still create their own POT and send to San Ysidro Health a copy of their POT with the TAR renewal package.

Independent Nurse Providers (INP-RN) will still create their own POT and send HHCM a copy of their POT with the TAR renewal package.

To get blank TARs forms 50-1, please follow these steps:

Providers can contact the DHCS provider service center at (800) 541-5555 to request paper TARs.

Select the following prompts when calling:

Option 6, Option 2, and then Option 1 for paper TARs.

Once you go through the correct prompts, the representative will ask for your NPI and your mailing address. DHCS will mail out additional TAR’s.

For new provider interested in become a HCBA Waiver Providers, please visit the website: https://www.dhcs.ca.gov/services/Pages/HCBSWaiver.aspx and contact us at Tarsubmission@syhealth.ORG

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Hours of Operation;

Mon. - Fri,   8:00 am to 5:00 pm

Contact us for any question about HCBA Waiver program at: (833)-503-5910

e-mail: caremanagement@syhealth.org

You could visit the Website from the Department of Health Care Services for more information about the HCBA Waiver program here.

Waiver participants and providers, could contact direct to DHCS for your comments and questions regarding the HCBA Waiver to: HCBAlternatives@dhcs.ca.gov  or call toll-free (833) 388-4551.

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