Health Homes: SPA 11-56 Update

1. Health Homes: SPA 11-56Update September 22, 2011 9:30AM

2. Letters of Intent • 165 LOIs received • Many comprehensive well thought through networks • Some concerns about specific network adequacy issues • Some LOIs have more comprehensive networks than others • Some overlapping regions and partners • Some smaller less robust entities that should merge • DOH is working with OMH, OASAS and NYCDOHMH to assess network adequacy and suggest additional network partners and any appropriate mergers

3. New Implementation Timeline for Health Homes Phasing in Health Home Implementation: • Phase I -13 counties • Applications due November 1 • Implementation January, 2012 • Phase II – Counties TBD • Target Implementation April, 2012 • Phase III-Counties TBD • Target Implementation June, 2012

4. Phase I Health Home Counties • Bronx • Brooklyn • Nassau • Monroe • Warren • Washington • Essex • Hamilton • Saratoga • Clinton • Franklin • St. Lawrence • Schenectady

5. Health Homes • Expect Designated lead Health Homes will be: • Community Based Organizations • Hospital Systems • Managed Care Plans • State expects lead Health Home entities to fully engage with their partners and that includes sharing the care coordination PMPM appropriately with partners based on care management effort.

6. Questions – Check the Website Please • The best resource to address questions is the website. Many questions are coming in that are already addressed on the web. • Please be sure to read the application information preamble BEFORE completing the application or asking questions to the HH mailbox; many of the questions are addressed in the preamble. • Please read the posted Q&As http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/questions_and_answers.htm

7. Questions-Table 1.1(Network Partners) Questions remain re: table 1.1 • Purpose of the table is to be a tool to assist with the assignment of patients into Health Home networks. • Use table 1.1 to identify each network provider in the lead entity’s organization, as well as associated individual practitioners for each of the partners. • Table is being revised for clarity

8. Application Questions - Table 2.1(Capacity) Questions remain re: Table 2.1 • The purpose of this table is assess capacity for each proposed Health Home • Health Homes will have some capacity in existing care management programs (TCMs, MATS, CIDPs). • Discussions re: which lead applicant should capture the slots for the existing care management programs should happen between lead Health Home applicants and the TCM/CIDP/MATS programs • New capacity is the number of Health Home members the Health Home can serve • Table is being amended for clarity

9. Application Questions (cont’d.) • Please complete application and only submit requested information and attachments. The State will request additional information from applicants if needed. • Do not submit contracts, letter of support, of linkage agreements. • The State will not be providing template contract language. Contracts are only needed between entities that will be exchanging money. MOUs or other linkage agreements are acceptable for referrals or relationships that will not result in the lead Health Home entity paying for coordination services. • State is working on getting a common patient consent form which will include consent for sharing information re: the HIV/AIDS, mental health and substance abuse between health home partners, including RHIOs.

10. Patient Attribution • The State will use a combination of the following to assign Medicaid enrollees to Health Homes: • 3M™ Clinical Risk Group (CRG), • an algorithm that predicts hospitalizations, and • behavioral health indicators • Medicaid enrollees will be assigned to a health home, to the extent possible, based on existing relationships with ambulatory, medical and behavioral health care providers or health care system relationships, geography, and/or qualifying condition. • Initial assignments will be for members who qualify for Health Home services are at high risk of future inpatient use and currently do not have a meaningful primary care or case management connection. • Patients will not be moved from their current TCM/COBRA, CIDP, MATS

11. Patient Attribution (cont’d) • The State will also include any supportive housing services an individual may have in keeping those connections in health home assignments. • Once assigned, enrollees will be given the option to choose another provider when available, or opt out of health home enrollment. • The State will provide health home providers a roster of assigned enrollees and current demographic and service access information to facilitate outreach and engagement. • With the exception of TCMs, where special arrangements may be made, Medicaid members enrolled with plans will be assigned into Health Homes by the health plan utilizing loyalty and attribution data provided by the State.

12. Rates • Rates were developed using three main variables • caseload variation (scaled from 11 to 1 at highest intensity end and 150 to 1 at lowest intensity end), • case management cost and • patient specific acuity. • The acuity groups were established from the 3M™ Clinical Risk Group software –with some adjustment to collapse some sicker patient groups (Catastrophic and Malignancies) into Pairs and Triples and HIV groups. • The clinical risk group software puts each patient in each health status group into a severity groups • Rates will be adjusted for functional status when such data becomes available. • Until functional status adjustments can be done - acuity factors were “up-weighted” for patients in groups likely to have lower functional status scores (MH/SA) and for patients in the mid and higher severity groups.

14. Rate Examples

15. Issues Under Development • Finalizing roles of responsibilities for managed care plans • Targeted Care Management transition • Timing and counties in phases II and III • Network adequacy review and feedback • Final CMS SPA roles (outreach and engagement; quality measures) • Rate adequacy feedback (HIV upweights, etc.)

16. Questions? • Join the Health Home Listserv and get updated health home information. Go to: http://nyhealth.gov/health_care/medicaid/program/medicaid_health_homes/index.htm. • Questions or comments regarding NYS implementation of Health Homes can be directed to hh2011@health.state.ny.us.