Archived Questions and Answers

Health Home Design

Table of Contents

  1. There are three levels of care described on in the Health Home website; application: low, intermediate and high. Please provide a detailed description of low and intermediate levels of care. Please describe the algorithm that will be used.
  2. Please provide a detailed description of ´service areas/geo–ZIP service areas´.
  3. Can organizations apply to serve only one of the target populations - for example people with hypertension and diabetes or people with mental illness? Will organizations that serve a narrower population be disadvantaged in the application process?
  4. Must a Health Home provide all three levels of care management intensity?
  5. Does DOH have guidance on staffing standards for the three levels of care coordination?
  6. All Medicaid participating hospitals will be required to have some sort of procedures for referring patients potentially eligible for Health Home services to Health Home providers. This applies regardless of whether the hospital participates in a Health Home network. Please confirm.
  7. Are there any specific patient ratios that the State is contemplating for low, intermediate and high need patients?
  8. Are there descriptions of what constitutes a low, intermediate and high need care management service?
  9. There is a federal mandate for hospital ER´s that treat people with chronic issues to connect individuals to designated Health Homes. Who is educating the hospitals about this requirement?
  10. Why are the Health Home leads so involved in the process of care coordination when they should be focused on an administrative role? Is it true that NYS has stated that Health Home Leads should be focused on outcomes rather than process?
  11. Health Home Care Plans will include activities like smoking cessation, wellness groups, peer run services etc. Will those services that are identified on the Care Plan now be approved for Medicaid Transportation?
  12. Can Medicaid dollars be used to pay for client travel to and from social service provider´s office, PCP, specialist, public assistance office, housing appointment etc.? Due to limited income a number of our clients are unable to attend vital appointments which affect their health. Is there Medicaid transportation reimburses for care plan development and review meetings?

Back to current Q&As

1. There are three levels of care described on in the Health Home website; application: low, intermediate and high. Please provide a detailed description of low and intermediate levels of care. Please describe the algorithm that will be used.

It is up to the Health Home to define those levels although the application gives a broad description of what that could mean.

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2. Please provide a detailed description of ´service areas/geo–ZIP service areas´.

Service areas can be defined by zip codes, boroughs or counties that a provider serves.

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3. Can organizations apply to serve only one of the target populations – for example people with hypertension and diabetes or people with mental illness? Will organizations that serve a narrower population be disadvantaged in the application process?

Health Home providers cannot specialize in specific populations; they must be able to serve all populations.

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4. Must a Health Home provide all three levels of care management intensity?

Yes.

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5. Does DOH have guidance on staffing standards for the three levels of care coordination?

No. It is up to each Health Home provider to determine the qualifications and staffing levels for their care managers.

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6. All Medicaid participating hospitals will be required to have some sort of procedures for referring patients potentially eligible for Health Home services to Health Home providers. This applies regardless of whether the hospital participates in a Health Home network. Please confirm.

Yes this is a requirement of the federal law authorizing Health Homes.

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7. Are there any specific patient ratios that the State is contemplating for low, intermediate and high need patients?

No. It is up to the Health Home to develop caseloads.

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8. Are there descriptions of what constitutes a low, intermediate and high need care management service?

Broad definitions were listed in the Health Home application to help define a low, intermediate and high need Health Home member. These definitions were presented as examples but each Health Home must determine the intensity of care management that is required for each category of Health Home members.

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9. There is a federal mandate for hospital ER's that treat people with chronic issues to connect individuals to designated Health Homes. Who is educating the hospitals about this requirement?

General guidance on community referrals is included in the Health Home Provider Manual and in the April 2013 Medicaid Update Health Home Special Edition.

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10. Why are the Health Home leads so involved in the process of care coordination when they should be focused on an administrative role? Is it true that NYS has stated that Health Home Leads should be focused on outcomes rather than process?

Lead Health Homes are not only responsible for an administrative role, they are also delivering Health Home care management services directly and with network partners while making decisions about how the Health Home should operate. Although the State has posted several required forms and assessments, the State anticipates that Health Homes may have other forms and assessments they will want to use to standardize the provision of care management. The State has stayed away from proscribing process and will be holding Health Homes responsible for meeting quality measures. Health Homes have the flexibility to decide the processes and policies to achieve the best outcomes.

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11. Health Home Care Plans will include activities like smoking cessation, wellness groups, peer run services etc. Will those services that are identified on the Care Plan now be approved for Medicaid Transportation?

Currently Medicaid transportation will only cover transportation for medically necessary services such as medical or behavioral health visits. Smoking cessation is a Medicaid covered service so transportation to smoking cessation services would be covered, but not transportation to wellness groups or peer run services, unless these services are part of a medically necessary service, e.g. OMH's Personalized Recovery Oriented Services (PROS).

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12. Can Medicaid dollars be used to pay for client travel to and from social service provider's office, PCP, specialist, public assistance office, housing appointment etc.? Due to limited income a number of our clients are unable to attend vital appointments which affect their health. Is there Medicaid transportation reimburses for care plan development and review meetings?

Medicaid transportation will reimburse for medically necessary services such as Health Home care management visits as well as medical and/or behavioral health visits.

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