Health Homes Designated to Serve Children Next Steps

  • Slides also available in Portable Document Format (PDF)
June 24, 2015

Congratulations and Thank You

  • On June 15, 2015 the State Agency Partner Review Team completed its review of Health Home Applications to Serve Children
  • Your Health Home was one of 16 approved Health Home Applications to Serve Children
  • On behalf of the State Partners, Congratulations!!
  • Thank you for your interest and commitment to providing Health Home care management to children and their families – we look forward to working with you to implement the design of the Health Home model for children

Overview of Today´s Webinar

  • Today´s Webinar will provide:
    • ✓ Assessment of the status of implementing the design features of Health Home model for children and updates to Health Home Enrollment Schedule
    • ✓ Next steps for lead Health Homes that have been designated to serve children
    • ✓ Question and Answers

Timeline for Enrollment:
Considerations for Assessing and Mitigating Readiness Risk

  • Upon completing the Application Review and Designation Process, and at the request of stakeholders (e.g., new and existing Health Homes designated to serve children, care management agencies and voluntary foster care agencies making readiness decisions) the State has assessed the overall "readiness risk" associated with implementing all key components of the Health Home Design for Children by the current October 1, 2015 launch date
  • While progress continues to be made, the State has concluded there is significant readiness risk around the October 1, 2015 date, including:
    • Programming, training, testing and launching MAPP modifications for children scheduled for October 1, 2015, including implementing:
      • Children´s referral and assignment portal process
      • CANS–NY (as modified) assessment tool in MAPP
      • The ability to integrate CANS–NY and Health Home rates in MAPP
      • Testing of and potential modifications to the CANS–NY assessment tool
      • Time for Designated Health Homes to meet contingencies and complete other administrative/readiness activities
      • Time for new care management agencies with expertise in serving children with complex needs to forge relationships with new and existing Health Homes
      • Time for Health Homes, Care Management Agencies and Plans to complete and participate in key trainings – MAPP, CANS–NY
      • Timing of CMS approval of State Plan Amendments

As part of the readiness risk assessment, the State also considered the effort and investments (such as budgetary, staffing and other readiness activities) that Health Homes and care management agencies will begin to make as well as the loss of a small amount of Health Home Development Funds (approximately $60,000 per designated Children´s Health Home).

Based upon all these factors, the State has concluded delaying the date to begin to enroll children in Health Homes to January 1, 2016 will ensure a smooth launch of the Health Home Design for Children and mitigate readiness risk.

Anticipated Schedule of Activities for Expanding Health Homes to Better Serve Children Due Date
Draft Health Home Application to Serve Children Released June 30, 2014 – Completed
Due Date to Submit Comments on Draft Health Home Application to Serve Children July 30, 2014 – Completed
Due Date to Submit Letter of Interest July 30, 2014 – Completed
Final Health Home Application to Serve Children Released November 3, 2014 – Completed
Due Date to Submit Health Home Application to Serve Children March 2, 2015 – Completed
Review and Approval of Health Home Applications to Serve Children by the State March 2, 2015 to June 15, 2015 – Completed
HH and Network Partner Readiness Activities June 15, 2015 to December 31, 2015
State Webinars, Training and Other Readiness Activities Through December 31, 2015
Begin Phasing in the Enrollment of Children in Health Homes January 2016
Children´s Behavioral Health Services and other Children´s Populations Transition to Managed Care January 2017 (NYC/LI)
July 2017 ROS

Signing June 15, 2015 Health Homes Serving Children Designation Letters and Verifying Contact Information

  • All 16 Designation Letters included contingencies
  • On or before June 30, 2015:
    1. Sign and return the June 15 letter if you agree to accept the Department´s Designation as a Health Home to Serve Children and to address the identified contingencies
      • ✓ Return your signed letter to:
        Health Home Program,
        NYS Department of Health,
        Office of Health Insurance Programs,
        Division of Program Development and Management,
        Corning Tower
        OCP – 720
        Albany, New York 12237
    2. Verify the primary contact information included with your Application and included on the list of Health Homes Designated to Serve Children posted to the Website is accurate – please submit any changes to hhsc@health.ny.gov – indicate "New contact information for Health Home Designated to Serve Children" in the subject line. This primary contact will be used by the Department to convey information related to Children´s Health Homes (e.g., webinars, design and implementation information, policies and standards)

NPI and MMIS Provider IDs for Lead Health Homes Designated to Serve Children

  • NPI number is required to obtain an MMIS provider ID
  • The MMIS provider ID will provide you access to eMedNY and is required to access the Health Commerce System (HCS) and for full access to Medicaid Analytics Performance Portal (MAPP) to perform Lead Health Home functions
  • Existing Health Homes that now serve adults and have been designated to serve children:
    • ✓ Option 1: Use current NPI and MMIS Provider IDs
    • ✓ Option 2: Apply for new NPI and MMIS Provider IDs
  • Which option you select is a business decision:
    • If you prefer to keep your adult and children care management lines separate, you may want to consider option 2 (e.g., under option 2, Health Home reports in MAPP would provide separate information on children under new provider ID while maintaining current information for adult members under current IDs)
    • Under option 1 information regarding adult and children members would be housed and reported together, however the Health Home can run reports to "filter" members by age
  • New Health Homes designated to serve children:
    • You must obtain an NPI and MMIS number
    • You may use the NPI/MMIS number provided on your Application or any other NPI/MMIS you have
  • On or before July 17, 2015 provide the Department with your Lead Children´s Health Home NPI and MMIS Provider ID or indicate if you are in the process of obtaining a new NPI and MMIS Provider ID by email hhsc@health.ny.gov– in subject line please indicate "Provider ID#s for Lead Designated Health Home to Serve Children"
  • Please email NPI/MMIS Provider ID questions to the Health Home email web form (link below) under the subject "Provider Enrollment/Provider and Network Partner Name Changes/NPI" or by call the Health Home provider line at (518) 473–5569
  • Process can be time consuming please, begin the process as soon as possible
  • Health Home email web form
  • Information about how to apply for NPI and MMIS provider IDs is posted on the NYS DOH eMedNY website

Access to Health Commerce System (HCS) for Lead Health Homes Serving Children

  • Lead Health Homes need MMIS Provider numbers to access HCS
  • HCS is required to provide access to MAPP and to training and assessment tools
  • Existing Health Homes – NO change in MMIS Provider ID
    • You already have access to HCS
      • ✓ Determine if you need to provide additional lead Health Home staff with access to HCS – work with HCS coordinator to ensure staff have active HCS User Account – MAPP Gatekeeper will receive instructions on assigning MAPP roles to staff)
  • New Health Homes and Existing Health Homes with new MMIS Provider ID
    • DOH will create an HCS organization account for the Lead Health Home
    • Webinar has been scheduled for July 9, 2015 to provide Lead Health Homes with information on how to designate HCS Director and Coordinator and how to establish HCS User Accounts for staff of the Lead Health Home
  • On or before July 17, 2015, using the form provided (Attachment C) please identify a single point of contact (SPOC) from your lead Health Home that will be the point person for HCS and MAPP access (existing Health Homes may list an already appointed SPOC). Submit form using the Health Home program email web link. Select "Health Commerce Accounts for Health Home" for the Subject line

Access to Health Commerce System (HCS) for your Health Home Care Management Agencies

  • Please provide a list of Health Home care management agencies that will provide care management and the Care Management Agency´s (CMA) SPOC
    • Using the Children´s Health Home CMA SPOC form provided by the Department at (Attachment A) provide a current list of care management agencies and their SPOC as you know it today / asap
    • Provide updates along the way by resubmitting entire updated list
    • Finalize and submit your updated provider network list along with your contingency letter due August 17, 2015
    • All lists and updates should be submitted to the Health Home program email web link. Select "Health Commerce Accounts for Health Home" for the Subject line
  • DOH will use your list to work with the Health Home Care Management Agencies to help them secure a "Health Home CMA" Org Type in HCS that is needed to ensure the CMA can access MAPP and training
  • CMAs must have entered into Business Associate Agreement with Lead Health Home to secure access to MAPP (i.e., with each Health Home it provides care management service to)
  • DOH will confirm you (i.e., the Lead Health Home) entered into and submitted Business Associate Agreement with the Care Management Agency
  • NOTE: Care management agencies must have MMIS# to access MAPP and be a Health Home CMA Org Type, and many Voluntary Foster Care Agencies you may be working with may not have, and will need to obtain, an MMIS provider ID

Access to MAPP for Lead Health Homes Designated to Serve Children

  • MAPP modifications for children will go live January 1, 2016 (see April 29, 2015 Webinar for more details)
  • Testing and training will begin in December 2015
    • HCS access required to access MAPP and MAPP training, BAA´s must be in place for CMA´s to access MAPP and MAPP training
  • The Department will work with the identified SPOC (the Lead Health Home´s SPOC and the CMA SPOC submitted to the Department by the Lead Health Home as discussed earlier in this presentation) to take the necessary steps to provide lead Health Homes and care management agencies access to MAPP

Data Exchange Application Agreements (DEAAs) – Between Lead Health Homes and DOH

  • Data Exchange Agreements are between Lead Health Homes and the Department of Health and allow the exchange of Medicaid member information
  • Existing Health Homes with no change in MMIS Provider ID do not have to submit new DEAA to the Department
  • New Health Homes and Existing Health Homes with new MMIS Provider ID must enter into DEAA with the Department
  • Health Homes must have DEAA in place to access MAPP
  • An MMIS Provider ID is required to complete DEAA (paperwork can begin now)
  • DEAAs should be completed as soon as possible, or by August 17, 2015
  • DEAA Contact: doh.sm.medicaid.data.exchange@health.ny.gov

Business Associate Agreements

  • Business Associate Agreements (i.e., subcontractor agreements) are between Lead Health Home and Care Management Agencies and are required to share information between Lead HHs and CMAs
  • Lead HHs should begin to work with CMAs now to enter into BAAs
  • DEAA must be in place prior to adding BAAs
  • New Health Homes or existing Health Homes that obtain a new MMIS Provider ID must obtain new BAAs with CMAs
  • Existing Health Homes with no change in MMIS Provider ID do not need to execute new BAAs with existing CMAs
  • BAAs must be in place to provide CMAs access to MAPP
  • BAAs are used to define relationships between CMAs and Lead Health Homes in MAPP (e.g., assignments etc.)
  • BAAs should be completed as soon as possible, or by September 1, 2015

Contingency Response Letter

  • On or before August 17, 2015 submit your Contingency Response Letter to the Department via email hhsc@health.ny.goventer "Contingency Response" in the subject line
  • Be sure to address all contingencies identified in the letter, including providing a list of ALL providers you have commitment letters or contracts in place to provide care management
  • Contingency Response Letters should be completed and emailed as a PDF document to hhsc@health.ny.govwith "Contingency Response" in the subject line.
  • Response letters will be reviewed by the State Review Team to determine Health Home "readiness"

Contingency Response Letter – Requirement to Submit Final Partner Network

  • As part of requirements for submitting the Contingency Response Letter, Health Homes must submit an updated Network Provider list
  • The Department will email the last version of the partner network list (including care management agencies) each Health Home submitted with its Application – please update this list
  • The Network Provider list is important tool that:
    1. Allows the Health Home to demonstrate to DOH a robust network that will adequately cover the Health Home´s area of service and include the specialty providers required to meet the special needs of children
    2. Assists MAPP in making assignments through the Children´s Referral and Assignment Portal
    3. Advertises to the community the Health Home´s network affiliations
  • On or before August 17, 2015
    • If you are an Existing Health Home and will have the same MMIS Provider ID for both adult and children´s Health Homes submit one updated partner network list containing both children´s and adult partners to the current Health Home Tracking System.
      • For Questions about submitting the updated partner network file to the Health Home Tracking System:
        Please contact Shiping Sun at shiping.sun@health.ny.gov
    • If you are a New Health Home OR Existing Health Home with new MMIS Provider ID submit the updated partner network containing only the providers that are associated with your children´s Health Home tohhsc@health.ny.govalong with your Contingency Response Letter

Contingency Response Letter – Health Home Administrative Capacity and Readiness

  • Newly designated Health Homes should take the opportunity in the Contingency Response letter to demonstrate its ability to meet the requirements and procedures for being a lead Health Home – even if you have a contractual relationship with an entity to assist you with administrative requirements
  • On or before October 1, 2015, all existing Health Homes (including those designated and NOT designated to serve children) and all Health Homes designated to serve children, that it has procedures in place that will allow it to make timely payments to care management agencies (i.e., within X days of receiving payments from Managed Care Plans) and that it has tested its ability to bill Managed Care Organizations for Health Home services and pass Health Home payments down to Care Management Agencies. Health Homes are required to include in the certification a description of their testing procedures.
  • To date, 3 Health Homes that are designated to serve children have provided the billing readiness certification

Administrative Service Agreements and Standards

  • Administrative Service Agreements are between the Plan and the Health Home – the Agreement under which Health Homes provide Health Home care management services to the Plan´s members in exchange for payments from the Plan
  • Modifications to the ASA are underdevelopment (see DOH website for latest draft) – discussions have been in the context of HARP members and Health Home but also apply to Health Homes serving children:
    • Recognition there is required assessments for children (i.e., CANS–NY)
    • Provides opportunities for Health Home to remedy deficiencies prior to severing ASA
    • Incorporation of Health Home Standards by reference
      • Amendments for children under development and have not yet been incorporated (e.g., care manager qualifications, face–to–face meetings)
      • State Agency Partners are considering other standards for children along the conceptual issues included for adults (supervisor qualifications, training for care managers)
      • Partners are working to finalize standards
  • New Health Homes should contract with as many plans in their region as possible – Health Home assignments made in MAPP will only be made where there is alignment between the Health Home and the Plan

Contracts with Care Management Agencies

  • Health Homes should begin to execute contracts with care managers
  • The State has not provided a standard document for this purpose
  • Contractual arrangements must be in place prior the first request for reimbursement

Health Information Technology (HIT) Requirements

  • Existing Health Homes designated to serve children will have three months from date of Health Home designation to meet compliance with HIT standards – on or before September 15, 2015
  • New Health Homes designated to serve children will have 18 months from date of Health Home designation to meet compliance with HIT standards – on or before December 15, 2016
  • Additional assistance can be obtained by contacting Scott Rader, HIT Analyst, Health Home Program at (518) 473–5569
Summary of Key Dates and Deliverables
On or before the following Dates: Deliverable
June 30, 2015
  • Sign and Return June 15 Designation Letter
  • Verify Primary Contact Information
July 9, 2015 Attend Webinar on HCS Access (10:00 a.m. additional information to follow)
July 17, 2015
  • Verify your NPI and MMIS Provider IDs for Designated Health Home to Serve Children or indicate you are in process of obtaining Provider IDs
  • Identify SPOC for your Lead Health Home for MAPP and HCS access (Attachment C)
August 17, 2015
  • Provide list of your downstream HH Care Management Agencies and their SPOC (Attachment A)
  • Finalize and submit your updated provider network list
  • Submit your Contingency Response Letter
ASAP or by August 17, 2015 Enter into DEAA with Department (Attachment D)
ASAP or by September 1, 2015 Enter into BAA with CMAs
September 15, 2015 (Existing Hhs)/
December 15,2016 (New HHs)		 Meet HIT Requirements
October 1, 2015 Submit Billing Readiness Certification
January 1, 2016 MAPP Go Live for Children (testing and training begins in December 2015)

Updates, Resources, Training Schedule and Questions

  • Please send any questions, comments or feedback on Health Homes Serving Children to: hhsc@health.ny.gov or contact the Health Home Program at the Department of Health at 518.473.5569
  • Stay current by visiting our website.

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