Medicaid Health Homes - State Plan Amendments

Implementation of Health Homes for Medicaid enrollees with chronic conditions was recommended by the Medicaid Redesign Team. As a result, this initiative was included in the Governor´s SFY11/12 Budget and was adopted into law effective April 1, 2011. Social Services Law (SSL) Section 365-L authorizes the Commissioner of Health, in collaboration with the Commissioners of the Office of Mental Health, Office of Alcohol and Substance Abuse Services, and the Office of People with Developmental Disabilities, to establish health homes for NYS Medicaid enrollees with chronic conditions.

Health Home Standards and Requirements for Health Homes, Care Management Providers and Managed Care Organizations

View Standards and Requirements

Medicaid State Plan Amendment (#24-0037)

  • 2.84% cost of living (COLA) adjustment for Health Home Plus (HH+)
  • Rate for supplemental payment for adults under Health Home Plus (HH+) and receiving Assisted Outpatient Treatment (AOT)

State Plan Amendment - #24-0037 (PDF)

Medicaid State Plan Amendment (#23-0062)

  • 4% cost of living (COLA) for Care Coordination Organization/Health Homes (CCO/HH)

State Plan Amendment - #23-0062 (PDF)

Medicaid State Plan Amendment (#23-0061)

  • 4% cost of living (COLA) adjustment for Health Home Plus (HH+)

State Plan Amendment - #23-0061 (PDF)

Medicaid State Plan Amendment (#22-0088)

  • Add assessment fee to the HH program for eligibility assessment for HCBS under the Children's HCBS waiver

State Plan Amendment - #22-0088 (PDF)

Medicaid State Plan Amendment (#22-0073)

  • 5.4% cost of living adjustment (COLA) for Care Coordination Organization/Health Homes (CCO/HH)

State Plan Amendment - #22-0073 (PDF)

Medicaid State Plan Amendment (#22-0072)

  • 1% across the board rate increase for Health Homes Serving Adults and Health Homes Serving Children
  • 5.4% cost of living adjustment for Health Home Plus (HH+)

State Plan Amendment - #22-0072 (PDF)

Medicaid State Plan Amendment (#21-0026)

  • Adding Sickle Cell Disease as single qualifying condition for Health Homes Serving Adults and Health Homes Serving Children

State Plan Amendment - #21-0026 (PDF)

Medicaid State Plan Amendment (#20-0054)

  • Adjusting Care Coordination Organization/Health Homes (CCO/HH) rates for historical rate setting

State Plan Amendment - #20-0054 (PDF)

Medicaid State Plan Amendment (#20-0034)

  • Eliminating separate per member/per (PMPM) month Outreach Payment to Health Homes Serving Adults and Health Homes Serving Children

State Plan Amendment - #20-0034 (PDF)

Medicaid State Plan Amendment (#19-0007)

  • Establishes transitional Children's HH rates for 1915(c) SED and B2H providers

State Plan Amendment - #19-0007 (PDF)

Medicaid State Plan Amendment (#18-0051)

  • Reducing per member/per month Outreach payment for Health Homes Serving Adults and Health Homes Serving Children
  • Eliminating the 9/30/18 expiration date for the per member/per month rates for Health Homes Serving Children
  • Adjusting rates for dates of service 6/1/18-12/31/18 for Health Homes Serving Children

State Plan Amendment - #18-0051 (PDF)

Medicaid State Plan Amendment (#17-0053)

  • Reducing case finding per member/per month fee and limiting billing to two months
  • Modifying rate structure for 3 tiers (Care Management, High Risk/High Need, Health Home Plus)

State Plan Amendment - #17-0053 (PDF)

Medicaid State Plan Amendment (#17-0025)

  • Establishing Care Coordination Organization/Health Homes (CCO/HH) Program Serving Individuals with Intellectual/Developmental Disabilities (I/DD)

State Plan Amendment - #17-0025 (PDF)

Medicaid State Plan Amendment (#16-0034)

  • Continuing Targeted Case Management rates at existing Health Home Legacy rates for Health Homes Serving Children

State Plan Amendment - #16-0034 (PDF)

Medicaid State Plan Amendment (#15-0020)

  • Establishing eligibility criteria for Health Homes Serving Children

State Plan Amendment - #15-0020 (PDF)

Medicaid State Plan Amendment (#15-0002)

  • Extending legacy rates (former Targeted Case Management) for Health Homes Serving Adults
  • Providing for a uniform case finding fee

State Plan Amendment - #15-0002 (PDF)

Medicaid State Plan Amendment (#14-0016)

  • Rate Add-on for Medicaid Redesign Team (MRT) fund distribution

State Plan Amendment - #14-0016 (PDF)

Medicaid State Plan Amendment (#13-63)

  • Extending existing Targeted Care Management (TCM) per member/per month rate

State Plan Amendment - #13-63 (PDF)

Medicaid State Plan Amendment (#13-18)

  • Continuing full Targeted Case Management program rates for two years

State Plan Amendment - #13-18 (PDF)

Medicaid State Plan Amendments (#12-10) and (#12-11) Phases 2 and 3

  • Phase 2 - Inclusion of additional counties for Health Homes Serving Adults

State Plan Amendment - #12-10 (PDF)

  • Phase 3 - Inclusion of final counties for Health Homes Serving Adults - statewide coverage

State Plan Amendment - #12-11 (PDF)

Medicaid State Plan Amendment (#11-56) Phase 1

  • Establishing the Health Homes Serving Adults Program - initial counties for implementation

State Plan Amendment (#11-56) (PDF)

NYS Medicaid State Plan Amendment (#11-56) Approved for Phase 1

Month-Year SPA # Policy/Guidance Change SPA Document(s)
January 2012 #11-56 Billing guidance issued by Webinar 12/9/11 and 1/12/12 State Plan Amendment (#11-56) (PDF)

NYS Medicaid State Plan Amendment (#11-56) Approved for Phase 1
April 2012 #12-10 Medicaid Update Vol 28- Number 4 State Plan Amendment - #12-10 (PDF)
July 2012 #12-11 Phase II Authority State Plan Amendment - #12-11 (PDF)
June 2013 #13-18 Health Homes Provider Manual Billing and Policy Guidance State Plan Amendment - #13-18 (PDF)

State Plan Amendment - #13-63 (PDF)
July 2014 #14-0016   State Plan Amendment - #14-0016 (PDF)