Questions and Answers

Q & A Topics

General | Billing and Payment | Chronic Illness Demonstration Project (CIDP) | Health Home Design | Health Home Development Funds | Health Home Letter of Intent/Applications/Provider Enrollment/Application Form | Health Home Network | Health Information Technology | Managed Care | Member Forms | Population Assignment/ Eligibility (Patient Tracking System) | Quality Metrics and Evaluation (CMART) | Spend Down | Targeted Case Management (TCM) |

General

  1. What is the difference between a Patient Centered Medical Home and a Health Home?
  2. Does the Health Home program include long term care services?
  3. Will NYS make Health Homes mandatory for Medicaid recipients?
  4. What is the role of OMH and NYCDOHMH in ensuring that providers, including former OMH TCM providers, have a connection to a health home?
  5. How will DOH adjust members´ acuity scores based on members´ evolving needs?
  6. Will the Health Home be responsible for coordinating all transportation needs?
  7. How will the issue of the high costs of homelessness be addressed where there is insufficient housing capacity?
  8. What is required for the State to share lists of Health Home candidates with Managed Care Plans and Health Homes?
  9. Can providers be part of more than one Health Home network?
  10. How can I find Medicaid providers in my county?
  11. Will the State assist in creation of standardized forms?
  12. Will the State provide training for Health Home staff?
  13. Do the Health Home eligibility lists provided include the language the client speaks?
  14. Are any resources being developed for the hearing impaired? Are there any DVDs or videos for Deaf individuals, in American Sign Language? They will not be able to understand the written consent.
  15. Does the Health Home have a Catalog of Federal Domestic Assistance (CFDA) number?
  16. Are the costs the State incurs in administering, overseeing, and assessing/reporting quality measures subject to the enhanced federal share? Are States able to claim the enhanced match for these activities, or the State´s regular federal share?
  17. Is there any funding available for Health Home implementation costs?
  18. Does the Fee–for–service (FFS) definition exclude all eligibles with managed care coverage or does FFS also include the persons whose services are provided on a FFS basis and not covered by the managed care benefit plan?
  19. Is the State working on developing specific documentation forms beyond the Member Tracking System? Can the MCO´s require specific documentation in addition? Is the lead Health Home responsible for developing any additional documentation forms?
  20. What role does a case manager representative payee play in the Health Home process?
  21. What is the relationship between Health Homes, MCOs and Behavioral Health Organizations (BHOs)?
  22. Will the lead Health Homes ever have to go through a process of re–applying/recertifying/etc.?
   Archived Questions
1. What is the difference between a Patient Centered Medical Home and a Health Home?

The Patient–Centered Medical Home (PCMH) is a model for care management provided by physician–led practices that seeks to strengthen the physician–patient relationship by replacing episodic care based on illnesses and individual´s complaints with coordinated care for all life stages, acute, chronic, preventive, and end of life, and a long–term therapeutic relationship. The physician–led care team is responsible for coordinating all of the individual´s health care needs, and arranges for appropriate care with other qualified physicians and support services.

The Health Home is a model of care management provided by community "care managers" who oversee and provide access to all of the services an individual needs to assure they stay healthy, out of the emergency room and out of the hospital. Care Managers build linkages to other community and social supports, and enhance coordination of medical and behavioral health care, with the main focus on the needs of persons with multiple chronic illnesses. Health Home services are provided through a network of organizations including health care providers, health plans and community–based organizations. All of an individual´s providers communicate with one another so the individual´s needs are addressed in a comprehensive manner.

The State Medicaid Director´s Letter (SMDL#10–024) provides a background and evolution of Patient Centered Medical Homes and Health Homes and can be accessed at https://www.cms.gov/smdl/downloads/SMD10024.pdf.

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2. Does the Health Home program include long term care services?

Health Homes are responsible for assuring that their members receive all necessary services, including long term care. However, members needing substantial long term care services, i.e., greater than 120 days may need to be transitioned into other LTC management programs e.g., Managed Long Term Care (MLTC) Plans. Individuals can be in both a Health Home and a MLTC plan. The Health Home and MLTC plan must have an administrative services agreement outlining their respective responsibilities.

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3. Will NYS make Health Homes mandatory for Medicaid recipients?

No, not at this time.

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4. What is the role of OMH and NYCDOHMH in ensuring that providers, including former OMH TCM providers, have a connection to a health home?

DOH, State Agency Partners (OMH, AIDS Institute and OASAS) along with NYC DOH MH, participated in the review of Health Home Letters of Intent (LOIs) and applications. This review ensured that TCMs are either the lead, or part of, Health Homes. In addition, the State Agency Partners continue to participate in ongoing Health Home redesignation visits to ensure Health Home networks have adequate connections with qualified and experienced providers.

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5. How will DOH adjust members´ acuity scores based on members´ evolving needs?

Members that are identified as potentially Health Home eligible will have a base acuity. The base acuity will be adjusted periodically based on Medicaid claims and encounter data. Health Homes can access the member´s base acuity score in the MAPP Health Home Tracking System. The base acuity is one of the factors used in the Health Home HML rate determination for service dates on/after December 2016 for Health Home members enrolled in Health Homes serving adults.

Prior to December 2016, the Health Home payments under rate codes 1386 and 1387 were based on the Health Home member´s adjusted acuity or Health Home weight. The adjusted acuity or Health Home weight includes the member´s base acuity plus upward weight adjustments that reflected a member´s HIV/SMI, risk and severity. Members that were not identified in the potentially Health Home eligible population were assigned the statewide average Health Home weight for payment purposes.

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6. Will the Health Home be responsible for coordinating all transportation needs?

Yes the Health Home is responsible to assist the member in coordinating all transportation needs. The Department of Health contracts with professional transportation managers to arrange and prior approve trips to Medicaid covered services in all counties of the state and New York City. The state´s transportation manager for Nassau and Suffolk counties is LogistiCare Solutions and for New York City and upstate the manager is Medical Answering Services (MAS).

For Medicaid Managed Care Health Home members there is a phase in schedule. Transportation is being carved out of the managed care benefit package and being covered by Medicaid fee–for–service using a transportation vendor. Please contact the managed care plan to find out if transportation is covered by the plan or covered by fee–for–service.

Eventually all transportation will be covered by Medicaid fee–for–service. Once the phase in schedule is complete the Health Homes will be notified.

https://www.emedny.org/providermanuals/transportation/pdfs/transportation_pa_guidelines_contact_list.pdf

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7. How will the issue of the high costs of homelessness be addressed where there is insufficient housing capacity?

The State is actively taking steps to increase housing capacity through the work of the Medicaid Redesign Team (MRT) Affordable Housing Workgroup. Information about these activities can be found here or here Health Homes must partner with both shelters and supportive housing providers to help navigate the local challenges, leverage opportunities and be part of local efforts to improve access to housing.

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8. What is required for the State to share lists of Health Home candidates with Managed Care Plans and Health Homes?

A Data Exchange Application and Agreement (DEAA) must be approved and access to the Health Commerce System must be obtained before any Medicaid Confidential Data (MCD) can be exchanged. Information on DEAAs can be found here under Administrative Requirements for Health Homes.

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9. Can providers be part of more than one Health Home network?

Yes. It is possible for a provider to join more than one Health Home network.

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10. How can I find Medicaid providers in my county?

There is no specific internet resource that identifies Medicaid providers by county. However, to obtain county information, care managers can contact the member´s MCO for a list of participating plan providers or access their MCO´s website. For Medicaid fee–for–service members, care mangers can utilize the New York State Physician Profile website here. Go to the "Click here to search for a physician" icon and then select the "Advanced Search" icon to select by a specific county.

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11. Will the State assist in creation of standardized forms?

DOH encourages the development of standardized forms and tools unique to each Health Home or among Health Homes, but DOH will not develop them, with the exception of the Consent Form (DOH 5055), Withdrawal of Consent (DOH 5058), Opt Out Form (DOH 5059), the member welcome letter template and HHSC Consent Forms: Health Home Consent Enrollment For Use with Children and Adolescents Under 18 Years of Age (DOH 5200), Health Home Consent Information Sharing For Use with Children and Adolescents Under 18 Years of Age (DOH 5201), Health Home Withdrawal of Health Home Enrollment and Information Sharing Consent Form For Use with Children and Adolescents Under 18 Years of Age (DOH 5202), Health Home Consent Information Sharing Release of Educational Records (DOH 5203), Health Home Consent Withdrawal of Release of Educational Records (DOH 5204) and Health Home Functional Assessment Consent (DOH 5230). The DOH consent forms including associated translations are available on the Health Home website under Forms and Templates click here to view and for Health Homes serving children forms click here.

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12. Will the State provide training for Health Home staff?

The Department is not offering training for staff of Health Homes at this time. Please check under the Partner Resources section of the Health Home Website for training resources. Health Homes received Health Home Development Funds (HHDF) with workforce training and retraining being one of the authorized funding categories. Health Homes can provide or pass HHDFs to Care Management Agencies for staff training. DOH is in the process of developing a Learning Management System (LMS) that will include Care Manager related training.

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13. Do the Health Home eligibility lists provided include the language the client speaks?

Medicaid Managed Care Plans may submit a member´s language to the MAPP HHTS when the MCP assigns a member to a Health Home. Once submitted in the system, the member´s plan provided language is available on the Health Home assignment file and the My Members download file.

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14. Are any resources being developed for the hearing impaired? Are there any DVDs or videos for Deaf individuals, in American Sign Language? They will not be able to understand the written consent.

Not at this time although the Heath Home provider must communicate and share information with individuals, their families and other caregivers with appropriate consideration for language, literacy and cultural preferences.

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15. Does the Health Home have a Catalog of Federal Domestic Assistance (CFDA) number?

Medical Assistance Program CDFA # 93.778. The Catalog of Federal Domestic Assistance (CFDA) provides a full listing of all Federal programs available to State and local governments (including the District of Columbia); federally–recognized Indian tribal governments; Territories (and possessions) of the United States; domestic public, quasi– public, and private profit and nonprofit organizations and institutions; specialized groups; and individuals

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16. Are the costs the State incurs in administering, overseeing, and assessing/reporting quality measures subject to the enhanced federal share? Are States able to claim the enhanced match for these activities, or the State´s regular federal share?

Only costs connected to the provision of Health Home services are eligible for the enhanced federal match.

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17. Is there any funding available for Health Home implementation costs?

Over 15 million dollars in Implementations Grants were awarded to Health Homes.

The State has received federal approval for an enhanced 1115 waiver to provide additional funds for Health Home Development; details on the process for distribution of both of these funding programs can be found here.

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18. Does the Fee–for–service (FFS) definition exclude all eligibles with managed care coverage or does FFS also include the persons whose services are provided on a FFS basis and not covered by the managed care benefit plan?

The FFS definition excludes all eligible individuals with managed care coverage (even if the Managed Care individual receives carved out services through FFS).

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19. Is the State working on developing specific documentation forms beyond the Member Tracking System? Can the MCO´s require specific documentation in addition? Is the lead Health Home responsible for developing any additional documentation forms?

Various forms, including Consent Forms and templates can be found on the Health Home website here and for the Health Homes Serving Children forms click here. In addition to populating the MAPP Health Home Tracking System (HHTS), Health Homes must work with their care management agencies to submit information on care management services through the Health Home Care Management Assessment and Reporting Tool or HH–CMART. Information on the HH–CMART can be found by clicking here. DOH may also request additional data utilizing DOH developed forms/templates, as needed.

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20. What role does a case manager representative payee play in the Health Home process?

A representative payee is a person or organization who acts as the receiver of United States Social Security Disability or Supplemental Security Income for a person who is not fully capable of managing their own benefits. Health Home care managers may not serve in this capacity.

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21. What is the relationship between Health Homes, MCOs and Behavioral Health Organizations (BHOs)?

All adult recipients who are eligible for Medicaid Managed Care (MMC) (excluding Medicare recipients and certain other populations), receive full physical and behavioral health benefits through managed care. Beginning October 1, 2015, plans began covering expanded behavioral health benefits. Also effective October 1, 2015, consumers enrolled in a MMC whose behavioral health benefit was covered under Fee for Service Medicaid through SSI began receiving these benefits through the MMC plan.

Adults enrolled in Medicaid and 21 years or older with select Serious Mental Illness (SMI) and Substance Use Disorder (SUD) diagnoses having serious behavioral health issues are eligible to enroll in a new type of health plan, HARP. These specialty lines of business operated by the MCO will be available statewide. Individuals meeting the HARP eligibility criteria who are already enrolled in an HIV Special Needs Plan may remain enrolled in the current plan and receive the enhanced benefits of a HARP. HARPs and SNPs will arrange for access to a benefit package of Home and Community Based Services (HCBS) for members who are determined eligible. HARPs and SNPs will contract with Health Homes, or other State designated entities, to develop a person–centered care plan and provide care management for all services within the care plan, including the HCBS.

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22. Will the lead Health Homes ever have to go through a process of re–applying/recertifying/etc.?

After the initial three year period of designation, the State Implementation partners (DOH, OMH, AI, and OASAS) will collaboratively review each Health Home´s performance to determine if the Health Home will be redesignated. State redesignation of Health Homes will be determined based on compliance with Federal and State program Standards and Requirements, chart reviews and performance data.

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