Session 4
August 29, 2012
AGENDA
• Implementation Updates
• Status of Health Home/MCP Contracts
• Billing Review/News
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• DOH has answered CMS questions on Phase II and
Phase III State Plan Amendments (SPAs)
• Enrollment/billing of new members in Phases II and
III cannot proceed until SPAs are approved.
• However, members in converting TCM programs in
Phase II counties should be collected by Health
Homes and submitted to DOH through the Member
Tracking System. At this time, Phase III members
should not be submitted to DOH.
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• Phase III designation letters are on the way. In the
meantime, newly designated Health Homes can:
• Ensure Health Commerce System (HCS) access
• Prepare updated network partner lists
• Enter into contract negotiations
• Health Home designations still pending for several
counties (Albany, Otsego, Schoharie, Delaware and
Chenango)
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Two types of Agreements:
Plan specific template or “Approved Agreement”
 Must include Key Provisions
 Can be used to negotiate a mutually acceptable contract with
Health Homes
 These are Administrative Services Agreements, not a Provider
Agreement – provider agreement language (e.g., credentialing
requirements) and/or appendices should not be included
Standard Agreement
 Basic contract that includes the Key Provisions
 Must be used as is with no modifications, or if modified, must
be submitted by Plan and becomes an “Approved Agreement”
All agreements must be submitted for review
and approval to DOH Bureau of Managed Care
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Emblem HIP
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Montefiore
Maimonides Medical Center
FEGS
Bronx Lebanon Medical Center
Institute for Family Living
Fidelis
VNS Schenectady
 Maimonides Medical Center
 Bronx Lebanon Medical Center
Healthfirst PHSP
 Bronx Lebanon Hospital Center
 Institute for Community Living
 Maimonides Medical Center
 FEGS Health & Human Services
 Community Healthcare Network
 Montefiore Medical Center
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Neighborhood Health Providers
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Bronx Lebanon Medical Center
Institute for Community Living
Maimonides Medical Center
Community Healthcare Network
Montefiore (BAHN)
VNS New York Home Care
Hudson Health Plan
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Hudson Valley Care Coalition
HealthPlus (Amerigroup)
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North Shore Long Island Jewish
MetroPlus
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NYC Health and Hospitals Corp.
UnitedHealthcare of New York
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Community Healthcare Network
Bronx Lebanon Hospital Center
FEGs Health and Hospital Services
System
*As of August 28, 2012
• TCM agencies bill eMEDNY directly for ALL
members. This includes FFS and MC members,
for legacy slots and Health Home slots.
• TCM agencies bill existing members for active
enrollment, even if they have not yet signed
the Health Home consent form.
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• Converting programs in Phase I can bill prospectively for members
in converting programs using program-specific (OMH TCM,
COBRA, MATS, CIDP) Health Home rates. Converting programs
cannot bill the New Health Home rates (1386/1387) until they
receive notice that the rates have been loaded onto their rate file
• New Health Home rates for converting programs will be based on
a programs (TCM/COBRA/CIDP) average acuity rather than a
provider specific acuity, due to low volume of submitted records.
Effective 10/1/12, all rates will be calculated using member level
acuity scores
• Joint OMH/DOH letter to OMH and COBRA TCM providers re: TCM
regulations no longer apply once Health Home services are billedwill be emailed/posted shortly
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