[NYAPRS Enews] OM: New York Medicaid Health Home Initiative Underway

Mon May 14 07:55:04 EDT 2012

New York Medicaid Health Home Initiative Underway

Open Minds   May 14, 2012

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_ho
mes/phase_1_plan_for_hh_apps.htm
<http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_h
omes/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_ho
mes/phase_2_plan_for_hh_apps.htm
<http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_h
omes/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:

1.	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
2.	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
3.	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
4.	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
5.	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
6.	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
<http://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
<http://www.openminds.com/library/020612mhcdnyshealthhomesspa.htm> .

Additional information is available online at
www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/que
stions_and_answers.htm
<http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_h
omes/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
<http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_h
omes> .

New York Medicaid Health Home Initiative Underway. (2012, May 14). OPEN
MINDS Weekly News Wire.

Read more: New York Medicaid Health Home Initiative Underway
<http://www.openminds.com/market-intelligence/basic/omolfree/051412mhcd8
.htm?#ixzz1uqGFdp5A>  
Copyright 2011. OPEN MINDS 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20120514/52791f3d/attachment.html>