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Health Home Implementation Update


Title: Health Home Update Author: Janice Thompson Last modified by: bkk02 Created Date: 8/3/2012 2:12:16 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Health Home Implementation Update

Health Home Implementation Update A Care
Management Partner Perspective
  • Session 9 January 17, 2013

  • Working Together
  • HIT Requirements and Funding Opportunities
  • Sharing Member Information
  • Member Eligibility for Health Home Services
  • Outreach and Engagement Work
  • Health Home Services
  • Acuity Scores
  • Billing and Rates

Working Together-The Role of TCMs in Health Homes
  • The States decision to pursue the Health Home
    (HH) model in a transformative way was predicated
    on the successes and lessons learned in OMH
    Targeted Case Management (TCM), HIV COBRA TCM,
    OASAS Managed Addiction Treatment Services
    (MATS), and DOH Chronic Illness Demonstration
    Project (CIDP)
  • HH providers integrate and coordinate all
    primary, acute, behavioral health, and community
    support services treating the whole person with
    the goal to improve care and reduce costs.

Working Together-The Role of TCMs in Health Homes
  • The HH model expands concepts from both
    converting case management programs and Patient
    Centered Medical Home model by building
    additional linkages and enhancing coordination
    and integration of medical and behavioral health
    care to better meet the needs of people with
    multiple chronic illnesses
  • In other words, the Health Home takes the Medical
    Home concept across multiple care disciplines and
    into the community for high need Medicaid

Working Together-The Role of TCMs in Health Homes
  • TCMs were developed to provide community-based
    case management to high need Medicaid recipients
    (HIV/Mental Health) often disengaged from
    medical, mental health, and social services
  • TCMs have years of experience in outreach and
    engagement of persons difficult to locate and
    keep in care
  • unstably housed
  • mentally ill
  • history of incarceration
  • substance using
  • with multiple chronic illnesses
  • impacted by stigma

Working Together-The Role of TCMs in Health Homes
  • HHs networks were approved only if they included
    converting case management programs in many
    cases multiple case management programs.
  • Lead HHs are expected to be using the value and
    expertise of their entire HH network to achieve
    the goals of the program.

Working Together Challenges
  • Case management programs operated successfully,
    but programs were not anchored into formal
    comprehensive networks with medical providers.
  • Under HH case management agencies are
    transitioning as part of larger networks.
  • TCMs are accountable to HH Leads often multiple
    leads with different requirements.
  • TCMs work to ensure client outcomes are realized
    provide direct service to locate/engage clients
    and coordinate member care and services.
  • TCM input into HH policies can help ensure more
    effective processes.

Working Together Challenges
  • Fiscal Viability
  • Converting programs ability to generate revenue
    to cover agency administrative and infrastructure
    costs are dependant on volume of assignments, and
    amount and timing of payments
  • Concern about future cash flow beyond direct
    Medicaid billing
  • Concern about survival beyond legacy rates
  • Administrative costs must be negotiated with
    multiple HH Leads and MCOs.
  • New infrastructure and HIT costs are not built
    into reimbursement impacting lead HHs and
    network partners alike.

Working Together Challenges
  • Administrative burden
  • Tracking enrollee status for multiple HH
  • Reporting to multiple MCOs and HH Leads
  • Requirements vary - some have added reporting
    elements beyond state requirements
  • Maintaining databases/EHRs for multiple HH and
    ensuring staff are trained to use them
  • Building capacity
  • Hiring, training, supervising staff
  • Oversight and quality assurance

Working Together-Lead Agencies and Converting
  • HH network partners have a joint responsibility
    to assure HH outcomes are reached. Establish
    systems to ensure
  • Clear, regular communication between HH Leads,
    MCOs, and converting care management providers
  • Policy input by all parties
  • Communication among HH systems in the same
    region, to avoid overlap and encourage
    collaboration (e.g., HUNNY, CNYHHN)

Maintaining Strong HH networks
  • State expects movement of partners as
    relationships develop.
  • HHs must notify DOH about changes to their
    network (changes in name, partners joining or
    leaving, etc). See instructions on the Health
    Home website http//
  • HHs are responsible to assure they maintain an
    ability to meet provider standards and
    qualifications much of which is met through
    comprehensive network partners working together.

HIT Requirements
  • Lead Health Home (HH) is responsible for assuring
    the HH network meets final HIT standards
  • Network care management partners are not required
    to join a RHIO but becoming a RHIO member will
    enhance the quality and quantity of EHR data
  • Lead HHs should be working with network partners
    to assure partners have any necessary HIT
    capability Work with the partners to fill in

HIT Requirements
  • Lead Health Home is responsible for a plan to
    adopt Certified Meaningful Use (MU) Electronic
    Health Records (EHR)
  • This HIT Standard applies to all Health Homes and
    is required for Clinical Partners/Provider
    Organizations providing clinical care to Health
    Home patients (including BHOs).
  • Care Managers do not necessarily need an EHR, but
    need an interoperable Care Plan application.
  • A future webinar will address this as well as
    other HIT related questions.

HIT Requirements
  • Partners should work with lead HH to understand
    how the HH will share information and meet HIT
  • Please contact Office of Health Information
    Technology Transformation for specific questions
  • E-mail
  • Phone 518-474-4987

HIT Funding
  • NYS recognizes expense of HIT infrastructure on
    Health Homes
  • Lead HHs and partner agencies have varying
    degrees of HIT infrastructure
  • NYS requested funding for HIT infrastructure
    through the CMS waiver
  • Funding would be prioritized for HH partners that
    have not already received funding through other

HIT Funding
  • NYS OMH is providing one-time HIT funding to
    assist former TCM providers to develop electronic
    care management system capacity to share
    information with their respective HHs.
  • HEAL 22 has funding to support technical
    assistance for Mental Health/Behavioral Health
    providers working with HHs.

Sharing Information
  • Access to member information is important to the
    entire HH network.
  • Currently only HHs and MCPs can access the Health
    Home member tracking file through the Health
    Commerce System (HCS).
  • DOH recognizes that network partners would like
    access to the HCS but current system and resource
    issues prevent the ability to give all network
    partners HCS access.

Sharing Information
  • DOH is looking to build a HH portal which would
    allow broader access and include additional
    features, such the ability to pull claims
  • In the interim, leads are responsible for sharing
    necessary information with the network partners.
  • DOH has a proposal to streamline the member
    tracking system process and will specify a
    standardized file layout to make it easier for
    network partners to manage data submission.

Sharing Information
  • Tracking system calls are held on a regular basis
    for Health Homes and MCPs because they currently
    submit files directly to NYS.
  • Network partners submit files through their HHs
    and are encouraged to obtain tracking system
    information from the respective HHs.
  • Information is also available at

Sharing Information
  • Health Home Restriction Exception (R/E) codes
    will be implemented in mid-2013. These codes will
    allow member look-up through eMedNY and other
  • This will be especially valuable to check before
    community referrals are made.
  • These codes will identify whether a member is
    potentially eligible for HH services and, if a
    member has been assigned, will identify the name
    of the members HH.

Sharing Information
  • Currently Health Homes and MCPs can only share
    the five most recent encounters of HH members.
  • Until the portal is developed, DOH will work with
    HH and MCPs to see what can be done to improve
    the member information provided to network
    partners, for both assignments and referrals.

Member Eligibility
  • New lists will be based on more up-to-date member
    eligibility information but eligibility can
  • Health Homes should verify member eligibility and
    assist members on maintaining Medicaid
  • Often Medicaid coverage is granted retroactively.
    However, the decision to provide it retroactively
    is up to the county of residence.

Member Eligibility
  • DOH is developing guidance on leveraging existing
    strategies for assisting clients with spend down.
  • New strategies are being explored, focused on
    maintaining eligibility for spend down members.
  • Health Homes should work closely with their Local
    Government Unit (LGU)
  • It will still be necessary to work with members
    on an individual basis to maintain eligibility.

Member Assignment
  • New lists for Phase 1 and the first set of lists
    for Phase 2 are being finalized and were just
  • Members may also be assigned to HHs by network
    partners through community referrals.
  • See Medicaid Update November Special Edition
  • Community referrals can be transmitted to the
    lead HH through the member tracking system.

Member Assignment
  • TCMs/MATS make assignments for their members
  • For members previously enrolled in TCM, MATS and
    CIDP programs, the member can choose which care
    manager they want as their HH care manager
  • For members of a plan that are not contracted
    with the TCMs/MATS HH the lead HH should contact
    the members plan to initiate contract
  • When a contract cannot be agreed upon, the member
    can either choose a different HH or different
  • The best option is for the HH and Plan to have a

Outreach and Engagement
  • As part of the States 1115 waiver, the Health
    Home development fund requested funds for a
    public education campaign to make it easier for
    outreach partners to engage with potential HH
  • Resources to assist with outreach will be made
    available on the Partner Resources section of the
    HH website.
  • The State is finalizing a letter HHs can use as
    part of their engagement materials that explains
    the Health Home program.

Outreach and Engagement
  • Center for Health Care Strategies (CHCS) with
    support from the New York Health Foundation is
    looking into launching an online community,
  • Designed to build on the Learning Collaborative.
  • Will provide a forum for online peer-to-peer
    exchange, between in-person Learning
    Collaborative meetings.
  • Will allow HH network care management partners to
    share best practices.
  • A demonstration of the sites features and
    functionality will occur soon.

Outreach and Engagement
  • HHs have three months to engage members if after
    three months a member is not found or cannot be
    engaged in active care management the member
    cannot be billed for
  • HHs may decide to continue to try and engage a
    member during this non-billable period at their
    discretion. Network partners and lead HHs
    agencies should discuss process.

Health Home Services
  • All clients who meet HH eligibility criteria can
    receive HH services regardless of the level of
    service intensity.
  • HHs are building capacity so members can be
    prioritized using acuity scores.
  • Health Homes who determine a member no longer
    needs HH services should discuss, with the
    member, the option of having their care
    management handled by a PCP and/or PCMH as
  • It is the clients choice to opt out or disenroll
    from a HH. At the time the client opts out or
    disenrolls, they should be informed of options to
    join other HHs and told they may return to their
    original HH at any time.

Health Home Services
  • If a member moves out of a county or borough, HH
    may continue to provide HH services to the
    member, if practicable.
  • If the members relocation makes it impractical
    for the HH to continue to provide services, the
    HH is responsible for transferring the members
    assignment to a HH of the members choice.
  • HHs are responsible for linking members to all
    the physical, behavioral, and social support
    services a member may need, including vocational
    and housing supports. These resources should be
    included in the HH network and made available.

Acuity Scores
  • Acuity scores will be recalculated quarterly
    based on updated claims and encounter data.
  • HHs and care management partners may not adjust
    acuity scores but the members FACT-GP scores, as
    well as other factors, will be used to adjust an
    individuals acuity score on a prospective basis.
  • HHs will be able to download the acuity scores
    from the OHIP Data Portal in the near future to
    share with network partners.

Acuity Scores
  • Claims for members with no established acuity
    score will be set to pend status.
  • DOH will receive notification of the pended
    claims and will then submit an average acuity
    score for that member to the payment system.
  • There will be a delay in payment, but the acuity
    score will trigger payment of the pended claim.

Billing and Rates
  • Converting care management partners can bill up
    to the level of their approved legacy slots at
    the legacy rate, and bill for additional or
    expansion slots at the HH rate.
  • New clients can be billed at either the legacy
    rate or the HH rate, provided the total number
    of approved legacy slots is not exceeded.
  • Clients in a MATS legacy slot must have an SUD

Billing and Rates
  • Legacy rates have been extended another year to
    allow converting care management partners time to
    transition to HH services by the end of the
    second year.  
  • DOH will monitor funding levels and make an
    assessment as to when legacy rates will convert
    to a blended or HH rate.

Billing and Rates
  • The HH rates were calculated to allow 6 for
    administrative costs, to be split between HHs and
    MCPs. A larger percentage is justified only if
    HHs and/or MCPs are providing additional support
    or services. Network partners should be asking
    for justification for any additional amount.
  • TCMs/MATS bill directly and some have negotiated
    an administrative contribution. DOH is working on
    ways to provide administrative support directly
    to MCPs and TCMs/MATS and will be conducting a
    survey to determine the extent to which these
    arrangements have been negotiated.

Billing and Rates
  • Providers that have already have Phase 1 rates
    loaded can bill for Phase 2. Phase 2 only
    providers will have to wait until rates are
    loaded to bill for Phase 2.
  • It is now anticipated that converting TCM claims
    will be reprocessed in early 2013.
  • A client can be referred to a HH based on a
    presumptive assessment. If the assessment reveals
    that the individual does not meet HH criteria,
    outreach and assessment can be billed for that

Useful contact information
  • Visit the Health Home website http//
  • Get updates from the Health Homes listserv. To
    subscribe send an email to listserv_at_listserv.hea
  • In the body of the message, type SUBSCRIBE
    HHOMES-L YourFirstName YourLastName
  • Email questions or comments hh2011_at_health.state.n
  • Call the Health Home Provider Support Line
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