OMH TCM Health Home Webinar
September 12, 2012
Phase 1
• Programs converted 1/1/12. Phase 1 SPA approved.
• Programs should submit patient tracking
information directly to assigned Health Homes.
• Providers should be billing Health Home rate codes
1851 & 1852 now.
• Rate codes 1386 & 1387 (based on OMH TCM
program average acuity) should be available for
billing within a few weeks with effective date of
3/1/12.
• Converting programs always bill Medicaid Directly
for Health Home services provided to both FFS and
Managed Care members.
Phase 2
• Programs converted 4/1/12 pending Phase 2 SPA
approval.
• The phase 2 SPA has not been approved, so
continue to bill pre-Health Home OMH TCM rate
codes until instructed to bill HH rates.
• DO NOT BILL USING THE NEW HH RATES UNTIL
INSTRUCTED TO DO SO.
• Programs should assign members in their programs
to an appropriate phase 1 or 2 Health Home and
submit members’ patient tracking to the assigned
Health Home. The HH will submit info to MCP/DOH
Phase 3
• Programs converted 7/1/12 pending Phase 3 SPA
approval.
• The phase 3 SPA has not been approved, so
continue to bill pre-Health Home OMH TCM rate
codes.
• DO NOT BILL USING THE NEW HH RATES UNTIL
INSTRUCTED TO DO SO.
• Programs should start to contact Health Homes
that they’d like to assign members to and establish
agreements. Do not submit patient information to
Health Homes until instructed to do so.
Patient Tracking System
• Converting Programs assign members to
appropriate Health Home.
• Converting Programs submit patient information
as outlined in HH Specifications Document to
Health Home (contact HH to determine how/when
to transmit patient info).
• Health Homes will submit FFS member info to
DOH and Managed Care member info to their
MCP.
• Health Home Specifications Document:
http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/2012-06-26_draft_hh_patient_tracking_system.pdf
• Health Home Patient Tracking & Billing website:
http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/rate_information.htm
Patient Tracking System Cont
• Only submit records when member is newly
enrolled or patient info changes.
• Begin date should correspond w/ begin date of
SPA or the first day of the month during which
services were first provided.
• Converting members will always have a
TCM/MATS/COBRA/CIDP Indicator value of Y
– This indicates to upstream providers that you are a
converting program and you will bill directly.
• TCM/MATS/COBRA/CIDP Slot Type must be E for
existing legacy rate (1851/52) or N for new HH rate
(1386/87).