Session 7
October 24, 2012
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Phase 1, 2 and 3 Updates
 Site Visits
Phase 2 & 3 SPAs
Managed Care Contracts
Provider Enrollment
Referral Guidance
 New Rate Calculations
Consent Forms
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Phase 1: All 13 Phase 1 Designated Health Homes have
approved Data Exchange Application Agreements
(DEAA) and have received HH eligible assignment lists

Phase 2: 14 of 21 Designated Health Homes have
approved DEAAs
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Phase 3: 10 of 17 Designated Health Homes have
signed and returned the designation letter and
responded to any contingencies

Designated Phase 3 Health Homes should be updating
their provider and organization lists in TREO
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ALL Phase 1 converting programs (OMH TCM,
MATS, COBRA, CIDP) should already have
submitted patient information to the Health
Homes that they are working with
 If you have not submitted ALL of your Phase 1
converting members to the Health Homes you
are working with you must do so immediately
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Converting OMH TCM, COBRA, and CIDP programs
located in Phase 2 counties must begin assigning
patients to Health Homes IMMEDIATELY
Converting programs should contact the Health Homes
they are working with to determine how the Health
Home would like the Patient Tracking System
information submitted
Health Homes will collect converting program
assignments and submit FFS member add records to
the OHIP Data Mart Portal on the HCS system
MCPs will collect converting program assignments
from Health Homes for their enrollees and will submit
add records to the Portal
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When initially submitting records for converting
members, the following fields must be populated
as shown below:
Record Type
A: Add record, since this is the first time the member has
been submitted to the system.
Begin Date
On or after the phase start date (4/1/12 phase 2 and
1/1/12 phase 1. Actual Begin Date depends on when
member enrolled in program)
Outreach/
E: enrollment. Since converting members are already
Enrollment Code receiving converting services they are automatically
enrolled in the HH program.
TCM/MATS/
Y: Indicates that the CMA is a converting case
COBRA/CIDP
management program and that the HH/MCP should not
Indicator
bill.
TCM/MATS/
E: if the CMA will bill using the existing legacy rate
COBRA/CIDP Slot N: if the CMA will bill using the new Health Home rate
Type
Referral Code
R: referral (since the member was referred to the Health
Home by the converting program, not DOH)
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DOH will exclude members from assignment by:
 excluding all members receiving active Health
Home services per the Tracking System
◦ Submitting converting member information upstream to
the Portal ensures that your patients will not be assigned by
DOH

excluding any member that has received a
converting case management service within
the last 6 months
◦ This approach WILL miss some due to claim lag or if
they are newly enrolled members
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Site visits to conduct readiness reviews are underway
for Phase 1 Health Homes
Visits will determine whether the Provider
Qualifications Standards and core CMS functional
requirements are being met
Health Home teams have visited seven of the thirteen
Phase 1 Designated Provider-led Health Homes
Overall, the Health Homes have met the federal and
state criteria for service delivery
Two designees need to work on integrating their
multidisciplinary teams for medical care
Health Homes that fail to meet the core expectations
will be placed on “notice”
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The main concern CMS continues to voice is that Health
Homes must be available to all categories of Medicaid
eligible members regardless of age, including children,
dual eligible individuals and waiver participants
Health Home services will be available to all categories
of Medicaid eligible members, but NYS will be phasing
in populations and prioritizing list assignments for
Medicaid recipients who meet the Health Home criteria
but do not yet have access to equivalent care
management
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Amida Care
• Institute for Community Living
• Community Healthcare Network
• Maimonides Medical Center
• VNS of NY Home Care
• Bronx Lebanon Hospital Center
CDPHP
• VNS of Schenectady
• Glens Falls Hospital
Emblem HIP
• Montefiore (BAHN)
• Maimonides Medical Center
• FEGS Health and Human Services
• Bronx Lebanon Hospital Center
• Institute for Community Living
• North Shore Long Island Jewish
Fidelis
• VNS Schenectady
• Maimonides Medical Center
• FEGS Health and Human Services
• Bronx Lebanon Hospital Center
• Institute for Community Living
• Montefiore (BAHN)
• Adirondack Health Institute
• Glens Falls Hospital
• VNS of NY Home Care
Healthfirst PHSP
•
Bronx Lebanon Hospital Center
•
Institute for Community Living
•
Maimonides Medical Center
•
FEGS Health & Human Services
•
Community Healthcare Network
•
Montefiore (BAHN)
•
North Shore Long Island Jewish
•
VNS of NY Home Care
Hudson Health Plan
•
Hudson Valley Care Coalition
•
Institute for Family Health
HealthPlus Amerigroup
•
North Shore Long Island Jewish
•
Bronx Lebanon Hospital Center
•
FEGS Health and Human Services
•
Maimonides Medical Center
Neighborhood Health Providers
•
Bronx Lebanon Hospital Center
•
Institute for Community Living
•
Maimonides Medical Center
•
Community Healthcare Network
•
Montefiore (BAHN)
•
VNS NY Home Care
MetroPlus
•
NYC Health and Hospitals Corp.
United Healthcare of New York
•
Community Healthcare Network
•
Bronx Lebanon Hospital Center
•
FEGS Health and Human Services
•
North Shore Long Island Jewish
•
Maimonides Medical Center
•
Hudson Valley Care Coalition
•
Glens Falls Hospital
VNSNY CHOICE
•
VNS of NY Home Care
•
Community Healthcare Network
•
Maimonides Medical Center
•
Institute for Community Living
•
Bronx Lebanon Hospital Center
Wellcare of NY
•
Bronx Lebanon Hospital Center
•
Institute for Community Living
* as of October 19, 2012
NOTE: The 11/7/12 Bi-weekly webinar will
focus on Health Home issues related to
Managed Care
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Phase 3 Designated Provider-Led Health Homes were
sent a NYS Medicaid Provider Designated HH
Information Chart electronically to be completed and
returned
Information is used to update Health Home enrollment
in the NYS Medicaid program
Health Homes must complete the chart and return it
by 10/26/12 to the HH mailbox at:
[email protected] with the subject line
“Provider Enrollment”
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If a HH has changed its name and/or NPI number from the
original submission the Notification Letter that was sent
through the HH mailbox to all HHs must be completed and
returned with the subject line “Provider Enrollment/Network
Changes”
A name change may require the HH to update the DEAA and
consent forms
The Notification Letter also provides an opportunity to update
any changes in partner network
The Notification Letter will be posted on the HH website soon
under “Forms and Templates
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
Designated Health Homes that hold certifications as clinics or
hospital-based providers under Article(s) 28,31 and/or 32 that
change their name and/or NPI# are requested to contact the
following agency staff for guidance:
◦ Article 28 - Keith McCarthy, Acting Director, Bureau of Project
Management, NYSDOH, (518) 402-0911
◦ Article 31 – Michael Holley, Director, Bureau of Inspection and
Certification, NYS Office of Mental Health, (518) 474-5570
◦ Article 32 – Janet Paloski, Acting Director, Bureau of Certification and
Systems Management, NYS Office of Alcoholism and Substance Abuse
Services, (518) 485-2250
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When assessing Health Home eligibility, members must meet
guidelines as described in the New York State Health Home State
Plan Amendment
Referrals for Fee-For-Service members go through the
Designated Health Home, referrals for managed care plan
members are made to the MCO (although the Health Home may
work with the MCO to facilitate referrals);
The referral process for converting TCM programs may differ and
must be made in consultation with the LGU Single Point of
Access (SPOA)
For interim guidance on Referrals, see slides 23-27 in the
October 10 (Session 6)webinar at:
http://www.health.ny.gov/health_care/medicaid/program/medi
caid_health_homes/meetings_webinars.htm
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Health Home rate calculations based on new measures
and acuity scores are effective October 10, 2012. The
acuity scores will be made available through the OHIP
HCS Portal
Claims submitted to eMedNY will automatically
calculate the new rate calculation
Another Medicaid Update Special Edition on Health
Homes with more detail on rates and other
information will be published soon
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The Health Home Patient Information Sharing Consent
Form (DOH-5055) has been revised and will be posted in
English on the HH website soon. Translations are underway.

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
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Both forms will be available at:
http://www.health.ny.gov/health_care/medicaid/program/
medicaid_health_homes/forms/#consent
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