New York Medicaid Health Home Initiative Underway
Open Minds May 14, 2012
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The New York Department of Health (DOH) is moving forward with the implementation of its Medicaid Health Homes initiative. The federal Centers for Medicare and Medicaid Services (CMS) approved New York’s Medicaid state plan amendment for the Health Home initiative on February 3, 2012, with an effective date of January 1, 2012. There are three enrollment waves for the Health Home initiative. Wave One, began on January 1, 2012 with phased-in enrollment of about 700,000 people with mental health and/or addiction disorders and chronic medical illnesses. Wave Two, to start in the spring of 2012, will enroll about 200,000 people needing long-term care support services. Wave Three, to start in the fall of 2012, will enroll about 50,000 people with developmental disabilities. Within each wave, enrollment will be phased in geographically. The state is in the process of rolling out Wave One; currently there are 34 approved Health Homes serving people in 23 counties.
The Wave One transition to Health Homes affects provider organizations offering targeted case management services under contracts with the Office of Mental Health, provider organizations offering HIV COBRA services, and provider organizations offering managed addiction treatment under contracts with the Office of Alcohol and Substance Abuse Services. The Wave One rollout is as follows:
- January 1, 2012-Phase I starts in 10 counties-61 provider organizations submitted Health Home applications. Eligible Medicaid beneficiaries in the 10 Phase I counties (Bronx, Clinton, Kings (Brooklyn), Essex, Franklin, Hamilton, Nassau, Schenectady, Warren, Washington) have already been enrolled and assigned to one of the 13 approved Health Homes listed here http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/phase_1_plan_for_hh_apps.htm.
- April 1, 2012-Phase II starts in 13 counties-37 provider organizations had submitted Health Homes applications by February 15, 2012, for DOH evaluation and approval to operate Health Homes in Dutchess, Erie, Manhattan, Monroe, Orange, Putnam, Queens, Richmond (Staten Island), Rockland, Suffolk, Sullivan, Ulster, and Westchester counties. Eligible Medicaid beneficiaries will be assigned to one of the 21 approved Health Homes listed here http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/phase_2_plan_for_hh_apps.htm.
- July 1, 2012-Phase III starts in the remaining 39 counties-Provider organization applications were due by May 1, 2012. DOH has not posted further information about the number of applications received nor how many applications were approved.
The Health Homes will receive a per-member per month (PMPM) care management fee for providing six core services:
- Comprehensive care management-This includes a comprehensive health assessment or reassessment inclusive of medical/behavioral/rehabilitative needs and long-term care and social service needs; revising the patient-centered plan of care with the patient to identify the patient’s needs and goals; consulting with a multidisciplinary team, primary care professional, and specialists regarding a client’s care plan/needs/or goals; conducting client outreach and engagement activities; and preparing a crisis plan
- Care coordination and health promotion-This includes coordinating with service providers and health plans as needed to secure needed care and share crisis intervention and emergency information; linking or referring clients to services in the care plan; conducting case reviews with the interdisciplinary team to monitor/evaluate client status; assist in scheduling services and coordinate with treating clinicians to assure that services are provided; and helping the client keep scheduled appointments
- Comprehensive transitional care-This includes following up with hospitals and emergency rooms when clients are admitted or discharged; facilitating discharge planning; linking clients with community supports; and following up post-discharge with the client and family to ensure that needed services are being provided
- Patient and family support-This includes developing, reviewing, and revising the individual’s plan of care with the client and family; consulting with the client, family, or caregiver on advance directives; meeting with the client and family and arranging for interpretation services as needed; and referring the client and family to peer supports, support groups, social services, or entitlement programs as needed
- Referral to community and social support services-This includes identifying resources and linking the client to community supports as needed and collaborating with community-based provider organizations to support effective utilization of services based on client and family need
- Use of health information technology to link services-This includes sharing client information and care plans electronically.
The PMPM care management reimbursement will be adjusted based on region, case mix, and patient functional status. The rates are the same for both governmental entities and private provider organizations providing Health Home services. The Health Home will receive the PMPM as long as active outreach and engagement or active care management, including care plan development, occurs in each billed month and one of the first five core services is also provided in each billed month.
The Health Homes are operated by Medicaid provider organizations that submitted a letter of intent (LOI) to DOH and later submitted a formal application for DOH approval to provide Health Home services during the roll-out for their service area. Eligible provider types include managed care plans; hospitals; mental and chemical dependency treatment clinics; primary care provider practices; patient-centered medical homes; federally qualified health clinics; targeted case management provider organizations; certified home health care provider organizations; and any other Medicaid-enrolled provider organization that meets the Health Home requirements.
Small provider organizations that cannot meet the Health Home Provider Qualification standards, but still wish to serve niche populations, must contact providers within their community regarding their interest in becoming part of a Health Home network. DOH accepted 165 letters of intent (LOI) from service provider organizations intending to provide health homes services through November 2011. Only these organizations are able to submit a formal application become a Health Home.
DOH will identify and assign Medicaid fee-for-service members meeting the Health Home criteria to specific state-approved Health Home provider organizations. The Health Home enrollment criteria are: two (or more) chronic health conditions, HIV/AIDS, or one serious and persistent mental illness. The initial DOH assignment to a Health Home provider organization will be based on two factors: Geographic proximity and provider loyalty (a composite of member service utilization with an organization for ambulatory, case management, emergency department, and inpatient care) within Health Home provider networks. DOH assigned each Health Home eligible individual a predictive composite score that combines the probability that a member will experience a negative outcome or death in the following year and the member’s level of connection with outpatient services. Health Homes are to prioritize their outreach to the highest risk individuals (as identified by the predictive score) and the highest cost members who have the lowest primary and ambulatory care connectivity in each Health Home area.
A link to the full text of “New York State Medicaid Update Introducing Health Homes” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/040112mhcdnyhealthhomes.htm.
The federal Centers for Medicare and Medicaid Services approved New York’s Medicaid State Plan Amendment to Implement Health Homes on February 6, 2012. The amendment is available in The OPEN MINDS Circle Library atwww.openminds.com/library/020612mhcdnyshealthhomesspa.htm.
Additional information is available online at www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/questions_and_answers.htm(accessed May 3, 2012).
For more information, contact: Public Affairs Office, New York Department of Health, Corning Tower, Empire State Plaza, Albany, New York 12237; 518-474-7354; Fax: 518-473-7071; Web site: www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes.
New York Medicaid Health Home Initiative Underway. (2012, May 14). OPEN MINDS Weekly News Wire.
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