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Health Home Implementation Update

Health Home Implementation Update. Session 7 October 24, 2012. Health Home Implementation Agenda. Phase 1, 2 and 3 Updates Site Visits Phase 2 & 3 SPAs Managed Care Contracts Provider Enrollment Referral Guidance New Rate Calculations Consent Forms. Phase 1,2 &3 Updates .

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Health Home Implementation Update

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  1. Health Home Implementation Update Session 7 October 24, 2012

  2. Health Home Implementation Agenda • Phase 1, 2 and 3 Updates • Site Visits • Phase 2 & 3 SPAs • Managed Care Contracts • Provider Enrollment • Referral Guidance • New Rate Calculations • Consent Forms

  3. Phase 1,2 &3 Updates • 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 • 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

  4. Phase 1 Converting Programs • 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

  5. Phase 2 Converting Programs • 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

  6. Converting Members & Tracking System When initially submitting records for converting members, the following fields must be populated as shown below:

  7. Release of Health Home Assignments 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

  8. Health Home Site Visits • 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”

  9. Phase 2 & 3 SPA Update • 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

  10. Managed Care and Health Home Contracts • 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

  11. Provider Enrollment • 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: hh2011@health.state.ny.us with the subject line “Provider Enrollment”

  12. Provider Enrollment • 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

  13. Provider Enrollment • 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

  14. Referral Guidance • 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/medicaid_health_homes/meetings_webinars.htm

  15. Rate Calculations • 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

  16. Consent Forms • 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 • Both forms will be available at: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/forms/#consent

  17. Questions?

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