Session 12– February 27, 2013
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Health Home Site Visits
Health Home Network Changes
Enrollment Billing and Rates
Assignment and Lists
Member Tracking System
Process Measures-CMART System
Funding Update
New Initiatives
BML-Hot Topics
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 Health Home program staff are conducting site visits to
evaluate the degree of readiness of Health Homes and assess
the adequacy of Health Home networks.
 Visits include an orientation with the lead Health Home to
review governance, lines of authority, data sharing and
degree to which the infrastructure is being developed to
provide integrated care management and a visit to a
downstream partner to evaluate direct care delivery.
 All Phase 1 and 2 site visits will be completed by April, Phase
3 site visits will begin in May.
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 Instructions and a template notification letter for Health Homes
that need to make changes to their name, NPI number, or their
provider network are available on the Health Home website.
 Health Homes are responsible for taking other actions that may
be required should they have a change in name, NPI or changes
in their network partners. Examples of changes that may be
required are executing new DEAAs or contracts, updating
network partner lists to ensure accurate member assignments,
or end dating records in the Member Tracking System.
 Program materials, e.g., consent forms, brochures, websites, etc
should be updated and uniformly reflect any changes in the
Health Home program name.
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Health Home rates have been loaded for all phases for
Health Home with Medicaid Provider IDs.
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Health Home COBRA rates have been loaded for all
phases.
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Phase 2 and 3 Health Home OMH TCM and MATS rates
have been approved and will be loaded onto provider
files in the next few weeks.
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New assignment lists for Phase 1 and 2 counties were
made available to Health Homes and Managed Care
Plans in January 2013.
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These lists supersede any previous lists that were
released. They also include dual-eligible (Medicaid
and Medicare) members.
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Phase 3 lists will be released mid-March.
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Changes to Member Tracking System to simplify and
streamline the process are expected to be in place by
March 18.
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The new member tracking system has been discussed
during the Health Home and Managed Care Plan
Member Tracking System weekly calls and a file layout
was distributed to participants on that call.
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If you have questions, send an email to the Health
Home mailbox at [email protected]
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The Health Home Care Management Assessment and Reporting
Tool (HH-CMART) was rolled out last week. This tool will collect
dates and types of services delivered to Health Home members,
for statistical purposes.
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Weekly technical assistance calls are scheduled on Wednesdays
from 10am-11am. Send an email to the Health Home mailbox to
sign up if you did not receive the invitation (use HH-CMART in
the subject line).
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Based on user feedback, the scope of data required to be
submitted for 2012 interventions has been reduced.
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The FACT–GP and Health Home Functional Assessment are still
needed for 2012 data submission.
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Funding for Health Home Infrastructure Grants is still
included in the State budget; funding will be delayed to
April 2014 but the funding authority remains in the 2013
budget in the event funds become available earlier.
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NYS will continue to pursue the infrastructure funding
that was included in the CMS waiver.
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A proposal to reimburse MCOs for Health Home
administrative costs through the capitated rate is being
considered as part of a package of MCO rate
adjustments.
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A model for enhancing Health Home services for those in
need of high intensity mental health care is under
discussion with OMH. This model, known as Health
Home Plus, will initially start in the metro area.
Populations under discussion include Assisted Outpatient
Treatment (AOT) individuals and those discharged from
Psychiatric Hospitals.
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DOH is applying to CMS for a demonstration project to
evaluate the outcomes for dual eligibles enrolled in
Health Homes; there is a potential for gainsharing in any
Medicare savings achieved.
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Questions for the Health Home program can be emailed
to the Health Home Bureau Mail Log (BML) at
[email protected]
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A new email address will be distributed shortly; the user
will be required to select a topic in order to send an
email. This will allow for more accurate distribution of
Health Home inquiries to appropriate staff (currently this
is done manually).
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Hot topics from the BML will be featured on these
webinars.
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When will translated consent forms be available?
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The Health Home Patient Information Sharing Consent Form (DOH5055) and the Health Home Withdrawal of Consent (DOH-5058)
have been posted in English on the Health Home website.
Translations are underway and will be available as soon as possible;
they have been delayed due to the need to rebid the NYS contract
for translation services.
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The Health Home Opt-out Form (DOH-5059) must be signed by a
current or eligible Health Home member if they do not want to
receive Health Home services. This is available in English, Spanish,
French, Russian, Chinese, Haitian Creole, Italian and Korean.
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Does a provider have to be part of the Health Home Network to be listed
on the Health Home Patient Information Sharing Consent Form DOH
5055?
 The DOH-5055 is the consent by the member to share data with a list
of providers. It does not matter if that provider is in the Health Home
network officially or not. For example, the member may be seeing a
specialist physician in another state or city for a very specific problem.
This specialist would never be in the full Health Home network but
would be part of the member's specific network for sharing of that
member's PHI only as part of care management and coordination.
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The Health Home could not share any other patient's information with
that provider, only this member's. It is expected that the most
commonly used type of partners would be in the Health Home, but
some may not be.
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What will the signed Health Home consent form allow?
The signing of the Health Home consent form will serve two
distinct functions.
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It will allow the Health Home care providers to share
member information;
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It will allow the lead Health Home to access patient
information directly from the local RHIO.
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If member’s consent is not required to initiate Health Home
services then why does a member need to sign a withdrawal of
consent form (DOH-5058) which also states that the member no
longer wishes to be a part of the Health Home?
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Member disenrollment from a Health Home program prior to
consent requires an opt out form (DOH 5059).
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If a consent has already been signed, then a signed Withdrawal
of Consent Form (DOH 5058) is required.
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Does DOH have to approve referrals for Health Home services?
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Potential members may be referred for Health Home services
from any source, these are known as community referrals.
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Members do not have to be on DOH lists or be approved by
DOH in order to be accepted for Health Home referral. Health
Homes and MCPs are responsible for determining whether the
individual presumptively meets criteria for referral.
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Health Home resources should be prioritized for the neediest
members. Each Health Home can develop criteria for evaluating
eligibility and need. Assessment for referral should include
three steps.
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STEP 1- ASSESS ELIGIBLITY: Must meet eligibility for Health Home
Services as described in the New York State Health Home State
Plan Amendment (claims data should be used whenever available
to verify medical and psychiatric diagnoses)
◦ Two chronic conditions (e.g., mental health condition, substance
use disorder, asthma, diabetes, heart disease, BMI over 25, or
other chronic conditions; OR
◦ One qualifying chronic condition (HIV + or AIDS) and the risk of
developing another; OR
◦ One serious mental illness.
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STEP 2-ASSESS APPROPRIATENESS FOR HEALTH HOME: Has significant
behavioral, medical or social risk factors which can be
modified/ameliorated through care management including any of the
following:
◦ Probable clinical risk for adverse event, e.g., death, disability,
inpatient or nursing home admission
◦ Lack of or inadequate social/family/housing support
◦ Lack of or inadequate connectivity with healthcare system
◦ Non-adherence to treatments or medication(s) or difficulty
managing medications
◦ Recent release from incarceration or psychiatric hospitalization
◦ Deficits in activities of daily living such as dressing, eating, etc
◦ Learning or cognition issues
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Other factors to be considered to determine the suitability of Health
Home services include a history of poor connectivity to care, including
but not limited to:
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No primary care practitioner (PCP)
No connection to specialty doctor or other practitioner
Poor compliance (does not keep appointments, etc)
Inappropriate ED use
Repeated recent hospitalization for preventable conditions either
medical or psychiatric
Recent release from incarceration
Cannot be effectively treated in an appropriately resourced patient
centered medical home
Homelessness
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STEP 3 -INITIATE REFERRAL: If member meets criteria described in Steps
1-2, the referral can be made on the basis of this presumptive
assessment.
◦ Referrals for FFS members are made to the lead Health Home,
referrals for plan members can go directly to the MCP or to the
lead Health Home to make the MCP connection.
◦ Health Homes and plans have access to assignment information in
the HCS portal and should check an individual’s assignment status
prior to making a referral.
◦ If the individual is already assigned to a Health Home, that Health
Home should be contacted to discuss the appropriate course of
action.
◦ Referrals are added to the Member Tracking System.
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Can two downstream providers share information about a specific
member with each other if each has a signed DEAA with the same
lead Health Home, but the member has not yet signed a consent?
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The DEAA allows for data exchange between the lead Health Home
and DOH, the lead Health Home then signs Business Associate
Agreements (BAAs) with network partners with which it will share
information prior to obtaining member consent (these are referred
to as subcontractors).
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If two network partners have each signed a BAA with the same lead
Health Home and member has not yet signed a consent form, the
two partners cannot share data between them. Data agreements
are for sharing between DOH and the Health Home and their
network partners (aka subcontractors).
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Do MCOs and Health Homes sign DEAAs as well or is the BAA
signed and executed with the State Standard Contract enough to
exchange Protected Health Information (PHI)?
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MCOs are not required to complete DEAAs with the
Department. The data they are accessing is for their own
patients, who have enrolled with them, and given the MCO
permission to share/exchange PHI.
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The Health Homes and MCOs execute contracts, which will include
a BAA that allows the MCO to share member PHI with the Health
Home.
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Questions?
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Visit the Health Home website:
http://www.health.ny.gov/health_care/medicaid/program/
medicaid_health_homes/
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Get updates from the Health Homes listserv. To subscribe
send an email to: [email protected].
 In the body of the message, type SUBSCRIBE HHOMES-L YourFirstName
YourLastName
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Email questions or comments: [email protected]
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Call the Health Home Provider Support Line: 518-473-5569
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