OMH TCM Health Home Webinar

1. OMH TCM Health Home Webinar September 12, 2012

2. Phase 1 • Programs converted 1/1/12. Phase 1 SPA approved. • Programs should submit patient tracking information directly to assigned Health Homes. • Providers should be billing Health Home rate codes 1851 & 1852 now. • Rate codes 1386 & 1387 (based on OMH TCM program average acuity) should be available for billing within a few weeks with effective date of 3/1/12. • Converting programs always bill Medicaid Directly for Health Home services provided to both FFS and Managed Care members.

3. Phase 2 • Programs converted 4/1/12 pending Phase 2 SPA approval. • The phase 2 SPA has not been approved, so continue to bill pre-Health Home OMH TCM rate codes until instructed to bill HH rates. • DO NOT BILL USING THE NEW HH RATES UNTIL INSTRUCTED TO DO SO. • Programs should assign members in their programs to an appropriate phase 1 or 2 Health Home and submit members’ patient tracking to the assigned Health Home. The HH will submit info to MCP/DOH

4. Phase 3 • Programs converted 7/1/12 pending Phase 3 SPA approval. • The phase 3 SPA has not been approved, so continue to bill pre-Health Home OMH TCM rate codes. • DO NOT BILL USING THE NEW HH RATES UNTIL INSTRUCTED TO DO SO. • Programs should start to contact Health Homes that they’d like to assign members to and establish agreements. Do not submit patient information to Health Homes until instructed to do so.

5. Patient Tracking System • Converting Programs assign members to appropriate Health Home. • Converting Programs submit patient information as outlined in HH Specifications Document to Health Home (contact HH to determine how/when to transmit patient info). • Health Homes will submit FFS member info to DOH and Managed Care member info to their MCP. • Health Home Specifications Document: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/2012-06-26_draft_hh_patient_tracking_system.pdf • Health Home Patient Tracking & Billing website: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/rate_information.htm

6. Patient Tracking System Cont • Only submit records when member is newly enrolled or patient info changes. • Begin date should correspond w/ begin date of SPA or the first day of the month during which services were first provided. • Converting members will always have a TCM/MATS/COBRA/CIDP Indicator value of Y • This indicates to upstream providers that you are a converting program and you will bill directly. • TCM/MATS/COBRA/CIDP Slot Type must be E for existing legacy rate (1851/52) or N for new HH rate (1386/87).