Session #31– January 8, 2014
Program Updates
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ACT and Health Home Integration
Health Home Enrollment and Billing Statistics
Housing Update
HARPs/BHOs and Health Homes
Works in Progress: Other Updates
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ACT AND HEALTH
HOMES
Assertive Community Treatment Program (ACT)
Joining Health Home Networks
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ACT Will Join Health Homes
• ACT will be part of Health Home networks, which will have
benefits for ACT recipients
• This required DOB approval of a $50 rate increase to
support ACT recipients in Health Homes
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ACT Will Join Health Homes
• ACT must enter into provider contracts with Health
Homes
• ACT programs may contract with more than one Health
Home
• Contract is needed so that –
• Funds can flow from the ACT Program to the Health
Home, and
• The Health Home can make its network available to
ACT recipients who have signed a Health Home
consent form
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ACT Will Join Health Homes
• Health Homes must also execute a Data Exchange
Application and Agreement (DEAA) Subcontractor Packet
agreement with ACT programs
• DEAA allows ACT and the Health Home to share
information provided by DOH to the Health Home, prior to
obtaining the ACT recipient’s consent: the last five claims
and other member demographic information
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ACT Will Join Health Homes
• ACT teams must now begin assigning Medicaid eligible
ACT recipients into Health Homes using the Health
Home’s Member Tracking
• ACT and Health Homes must have an executed DEAA in
order to transmit patient information
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What are the goals and benefits?
• Health Homes will provide individuals access to a wide
network of health providers
• All of an individual's caregivers communicate with one
another to address his or her needs in a comprehensive
way
• ACT teams will be able to more easily access step down
care management at discharge
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Benefits of Health Homes
• Monitor and provide linkage to all the network services an
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individual needs to stay healthy
Reduce emergency room, inpatient hospital and long term
care facility use
Improve health outcomes for populations
Reduce Costs
Continuity of care within the Health Home environment
Improve flow through the ACT program
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Reimbursement
• DOH approval is final. eMedNY will begin re-adjudicating
ACT claims back to July 1, 2013
• ACT programs were notified of rate increase on
December 6, 2013
• Claims may be re-processed prior to ACT executing
contract with the Health Home
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Fiscal
• Programs will receive retroactive increase in the monthly
reimbursement, July 1 through the present. Increase is to
be used for costs of preparing infrastructure, new IT and
recordkeeping requirements, etc.
• When ACT recipients are enrolled in Health Homes, ACT
teams will forward $30 of the $50 increase to the Health
Home as an administrative fee. The ACT program will
retain the $20 balance for the new responsibilities and
additional costs associated with being part of a Health
Home
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Assignment & Enrollment
• ACT should determine whether all current ACT recipients
with active Medicaid are already assigned to or enrolled in
a Health Home
• If an ACT recipient is already enrolled, contact the Health
Home and inform them that ACT is providing the care
coordination (requires a executed DEAA)
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Assignment & Enrollment, Con’t.
• To assign ACT recipients with active Medicaid, complete
and submit member tracking information to the Health
Home(s) in the format the Health Home requires (requires
a completed DEAA)
• To enroll ACT recipients who have signed a Health Home
consent form, indicate on the Health Home’s Member
Tracking that the individual is in active care management
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Enrollment Forms
• ACT must work with recipients to secure consent to
participate in the Health Home program (Health Home
Patient Information Sharing Consent Form, DOH-5055)
• ACT is responsible for helping ACT recipients understand
and complete the form
• The Health Home Consent Form allows the Health Home
network partners listed on the form to share appropriate
information to assist the member
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Health Home Assessment
• ACT Programs must ensure that a FACT-GP and the HH
Functional Assessment are completed for all ACT
recipients when they enroll in a Health Home, annually,
and when they disenroll
• ACT will return the FACT-GP to the Health Home(s)
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Reimbursement
• Populate the Direct Biller field of the Patient Tracking
Form with the value of “Y.” This indicates to the Health
Home that the downstream care management agency – in
this case the ACT Program – bills eMedNY directly for
services
• The rate increase will be effective as of July 1, 2013 (July
31, 2013 billing)
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Reporting
• In addition to the member tracking information, Health
Homes require a single plan of care documenting the care
management activities for individuals who have signed a
Health Home consent
• ACT teams must document care management activities in
the Health Home single plan of care, and provide at least
one Health Home Care Management service per month
• It will be up to the ACT Team and the HH to develop a
system of communication
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Next Steps for ACT & Health Homes
• Execute DEAA and contract between ACT and Health
Home(s)
• ACT begin assigning ACT recipients into Health Homes
by completing and transmitting Member Tracking
information in whatever format the Health Home requires.
Only demographic information may be shared prior to
obtaining a signed consent form
• When ACT recipients sign the Health Home consent,
indicate that the recipient is in active care management in
the Health Home’s Member Tracking
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Next Steps for ACT & Health Homes
• Complete Health Home FACT-GP and Health Home
Functional Assessment and submit to the Health Home
• ACT is required to work with the Health Home to provide
information needed by the Health Home
• Member Tracking
• Health Home FACT-GP and
• Health Home Functional Assessment
• Health Home Care Management record
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Statewide Health Home Enrollment – Claims Data Since Program Inception
(Based on January 2012 to December 2013 Claims)
48 HHs (32 Unique Entities) Designated under 3 Phases effective 1/1/12, 4/1/12, 7/1/12
Converting Members
# of HH Recipients Engaged in Outreach
5,692
New Members
# of HH Recipients Engaged in Outreach
87,762
Converting Members
# of HH Recipients Engaged in Active Care Management
41,157
New Members
# of HH Recipients Engaged in Active Care Management
36,152
Total # HH Recipients (Distinct count)
Total Health Home Eligible Individuals (MHSA and others)
141,521
805,000
# of Higher Risk Members
446,000
Higher risk members are identified based on predictive risk model and ambulatory connectivity measure; e.g.,those with
lower ambulatory connectivity and those more likely to die or have an inpatient or nursing home admission)
% of Higher Risk Members
55%
% of Higher Risk Members Enrolled or in Outreach
32%
As of December 26, 2013 there were about 74,000 members in Health Home Tracking System
(50,000 active care management/24,000 in outreach)
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Total-to-Date Health Home Claims with DOS between Jan. 2012 to Dec. 2013
Rate Summary
Health Home Case Mgmt Svcs (Converting)
Heatlh Home Outreach (Converting)
Health Home Outreach (New Slots)
Health Home Services (New Slots)
Totals (Rate Summary)
Unique
Recipients
w/MA Svc
Claims
41,157
5,692
87,762
36,152
141,521
MA Service
Claim Ct
MA Svcs Paid
346,866 $198,927,760
10,144
$4,983,320
185,023 $25,262,083
142,939 $30,212,031
684,972 $259,385,194
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• Statistics on numbers of members in the tracking system as
compared to paid claims were shared with each Health Home.
 Follow-up c alls were made to individual Health Homes to
help them identify and correct discrepancies.
• OMH TCM programs were given until the end of December 2013
to populate the tracking system for their respective Health
Homes.
 Once the OMH TCM programs have completed these
submissions, the Tracking System data will be used to match
members to paid claims so that OMH TCM claims can be
reprocessed.
• The tracking system vs. paid claims statistics will then be refreshed
and shared with Health Homes.
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Health Homes and Housing
• MRT Supportive Housing Health Home Pilot Program RFA
expected to be released in early February
• RFA will seek applications from Supportive Housing Providers for funds
to provide rental subsidies and/or on site community based services to
provide housing for homeless or unstably housed Medicaid members
enrolled in Health Homes
 Supportive Housing Applicants will required to identify and
receive commitment of one or more designated Health Homes to
be the Provider’s partner in implementing the RFA funds
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• A webinar was held and an RFQ has been released to provide an
opportunity for stakeholders to submit questions about the HARP
benefit plan. Deadline to submit questions has been extended to
January 17.
• The State submitted a Behavioral Health 1115 Waiver Amendment
to CMS on December 30, along with a response to 106 questions
posed by CMS based on preliminary discussions. This amendment
will amend the State’s Partnership Plan to authorize the expansion of
Behavioral Health services into Managed Care.
• The RFQ and Behavioral Health Waiver amendment materials are
posted at the link below (click on the link and then on the Behavioral
Health Transition tab on the left)
•http://www.health.ny.gov/health_care/medicaid/redesign/
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 Briefings have been provided to NYC-based Health Homes
and MLTC plans that will be participating in the first stage
of transitioning Adult Home residents to the community.
 Continued discussions/work with stakeholders on:
◦ Models for enrollment of Children in Health Homes.
◦ Development of Health Home Plus, an enhanced model
for AOT and other high-intensity populations.
◦ Best Practice Guidelines for Hospitals to Develop CMS
required referral process to Health Homes
◦ Clarifying Health Home policies and procedures on
eligibility and MLTC/HH enrollment
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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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To email Health Homes, visit the Health Home Website and click on the tab
“Email Health Homes”
http://www.health.ny.gov/health_care/medicaid/program/medicaid_health
_homes/
Call the Health Home Provider Support Line: 518-473-5569
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