State Administrative Health Home Service Agreement (ASA) Letter

  • Letter is also available in Portable Document Format (PDF)

November 13, 2024

Dear Managed Long Term Care Partial Capitation (MLTCP) and Medicaid Advantage Plus (MAP) Plans and Health Homes:

The purpose of this communication is to provide instruction regarding the use of this November 2024 updated Administrative Health Home Service Agreement (ASA) template described below to be used by both Managed Long Term Care Partial Capitation plans (MLTCP) and Medicaid Advantage Plus (MAP) plans in contracting with Health Homes.

As Programs of All- Inclusive Care for the Elderly (PACE) are required by federal regulation to provide consumers with an interdisciplinary team approach to develop person-centered care plans and to provide ongoing care management, this instructional letter does not apply to PACE.

Updated Documentation

As noted below in #1, the Department has updated the 2016 ASA template with a new Appendix A and Appendix B to be used respectively by MLTCP and/or MAP plans. MLTCP and/or MAP plans must use the updated ASA and appropriate Appendix A or Appendix B in Health Home contract renewals no later than March 31, 2025.

Plans must also utilize the documents in #2, #3 and #4 below when collaborating with Health Homes on behalf of their members. Please note that neither the updated ASA template nor the Statement and Certification documents should be altered.

  1. Statewide Administrative Health Home Services Agreement Between Managed Long Term Care Partial Capitation (MLTCP) and/or Medicaid Advantage Plus (MAP) Plans and Health Homes (updated November 13, 2024)
    • Appendix A MLTC Partial Capitation (MLTPC) Services
    • Appendix B Medicaid Advantage Plus (MAP) Services
  2. Guidance for Providing Care Coordination and Management to Medicaid Members Enrolled in MLTC Plans and Health Homes; and
  3. Statement and Certification.
  4. Care Planning and Coordination Form

These documents can be found at MRT 90 Health Plans, Providers, and Professionals (ny.gov). Select menu option: MLTC Plan and Health Home Collaborations- Statewide Documents.

Background

Pursuant to a March 2016 legal settlement regarding seriously and persistently mentally ill residents of adult care facilities in New York City (referred to as Disability Advocates, Inc. 2 (DAI2), the O'Toole, and/or the Adult Homes Settlement), MLTCPs and MAP plans, in New York City, in conjunction with Health Homes, must implement requirements related to the legal settlement. The Care Planning and Coordination document #4 above was developed pursuant to this class action settlement and is the recommended vehicle to promote successful Health Home and MLTCP and/or MAP care planning partnerships.

Weekly Report Obligations for DAI Class Members who are Plan Enrollees

MLTCP and MAP Plans continue to receive weekly reports sent via email from the Office of Community Transitions of their plan enrollees who are also protected DAI2 class action members. The weekly reports contain MLTCP or MAP Plan enrollee information, the enrollee's desire to move to the community, identification of the current Health Home and Care Management Agency assisting the plan enrollee and other demographic information.

As an enrollee who is also a class action member prepares to be transitioned from their Adult Home residence into community housing, the MLTCP and MAP plan is responsible to ensure the Person Centered Service Planning (PCSP) process is re- initiated and updated, including the provision of daily nursing (e.g., wound care, daily insulin injections, etc.) if these services are needed to transition an enrollee from an Adult Home to a community-based setting. This ensures Home and Community Based Service (HCBS) standards are met. The enrollee/class action member is the driver of their PCSP goals in collaboration with the care management team (Adult Home Plus care manager, Health Home or Health Home Plus care manager, MLTCP or MAP Plan care manager, and Plan contracted care managers). The PCSP process should identify services needed pre/during/post transition/discharge from the enrollee's current Adult Home residence.

MLTCP and MAP Plans continue to be responsible for providing timely written notice to enrollees if services are reduced or denied and the care management team should assist the individual in deciding on their next best course of action for service planning.

Health Home and ML TC Plan Confidentiality Attestation

To satisfy the current confidentiality language for third party contract requirements of DOH Privacy and Security, both MLTCP and MAP plans must also ensure their contracted Health Homes, which have access to enrollees' Medicaid confidential data, execute the Confidentiality Attestation which is attached to this communication and also posted here: MRT 90 Health Plans, Providers. and Professionals (ny.gov). Select menu option: MLTC Plan and Health Home Collaborations - Statewide Documents.

The completed attestation must be filed with DOH Privacy and Security at:

,doh.sm.medicaid.data.exchange@health.ny.gov  .

Questions:

If your plan has questions about:

  • implementing the type of collaboration described above. please submit your questions to.MLTCinfo@health.nyJgOY. with the subject line Adult Home DAI Settlement, and copy your MLTCP or MAP plan manager.
  • Adult Home Plus Health Home program. contact AHPlusProgram@health.ny.gov.
  • Health Home program issues, contact.healthhomes@health..ny.go)l.

Sincerely.

Susan U. Montgomery, Director
Division of Health Plan Contracting and Oversight
Office of Health Insurance Programs

Trisha Shell-Guy, Director
Division of Program Development and Management
Office of Health Insurance Programs