Visit us online: www.nyhealth.gov
New York State
SPECIAL EDITION
APRIL 2012
VOLUME 28 - NUMBER 4
T H E O F F I1.C I A L N E W S L E T T E R O F T H E N E W Y O R K S T A T E M E D I C A I D P R O G R A M
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Overview
A Coordinated Effort
Andrew M. Cuomo
GOVERNOR
State of New York
Nirav R. Shah, M.D., M.P.H
COMMISSIONER
New York State DOH
Jason A. Helgerson
MEDICAID DIRECTOR &
DEPUTY COMMISSIONER
Office of Health Insurance Programs
The Medicaid Update is a monthly
publication of the New York State
Department of Health.
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
What is a Health Home?
Identifying the Need
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
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INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Implementation
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Provider Standards
How it will Work
Assignment Algorithm
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Member Consent
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Member Assignment
Health Home Referrals
Sharing Member Information
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Outreach & Engagement
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INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Health Home Member Tracking System
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Core Health Home Services
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
HEALTH HOME SERVICES MINIMUM BILLING STANDARDS
CORE HEALTH
HOME SERVICES
Comprehensive
Care
Management
EXAMPLES OF CORE HEALTH HOME
SERVICES INTERVENTIONS/ACTIVITIES
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Care
Coordination &
Health
Promotion
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Comprehensive
Transitional Care
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Patient & Family
Support
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Referral to
Community &
Social Support
Services
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INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Care Management Metrics
Quality Metrics
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Provider Enrollment
Health Home Rate Code Definitions
Converting Legacy Slots
1851: Health Home/OMH TCM
1852: Health Home Outreach /OMH TCM
1880: Health Home/AIDS/HIV Case Management
1881: Health Home Outreach/ AIDS/HIV Case Management
1882: Health Home/ MATS
1883: Health Home Outreach/MATS
1885: Health Home/CIDP Case Management
New Health Home Slots
1386: Health Home Services (Plans and FFS)
1387: Health Home Outreach (Plans and FFS)
Claim Submission
Rate Sharing
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Rate Information & Determination
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Billing for Health Home Services
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Special Rules for Converting
Case Management Billing
Legacy/Existing Slot Billing
 CIDP contracts ended on March 29, 2012.
 By March 29 all CIDPs must be in a Health Home partnership
to continue to provide care management services.
For one year as of the effective date of appropriate SPA,
CIDPs, converting to Health Homes, may bill eMedNY directly
for existing CIDP members converting to Health Homes with
the new CIDP/Health Home rate code.
 New Health Home members assigned to a CIDP for Care
Management will be billed for by the Provider-led Health
Home or Managed Care Organization.
New Health Home Slot Billing
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Sample Acuity Score/Payment Relationship
$500
Rate Adjustment
$400
$300
$200
$100
$0
Downstate Monthly Payment
Upstate Monthly Payment
Sample Dx/Payment Relationship
Downstate Monthly Payment
Upstate Monthly Payment
$387
$413
$311
$39 $32
$109
$88
$135 $140 $148
$108 $112 $119
$166 $166
$134
$134
$184
$148
$205
$235
$165
$236
$189
$253
$259
$189 $203
$259
$208
$208
$332
INTRODUCING HEALTH HOMES
Improving Care for Medicaid Recipients with Chronic Conditions
Expansion Timeline
Discontinuing Services
Additional Information