Session 12– February 27,

2  Health Home Site Visits  Health Home Network Changes  Enrollment Billing and Rates  Assignment and Lists  Member Tracking System  Process Measures-CMART System  Funding Update  New Initiatives  BML-Hot Topics

3  Health Home program staff are conducting site visits to evaluate the degree of readiness of Health Homes and assess the adequacy of Health Home networks.  Visits include an orientation with the lead Health Home to review governance, lines of authority, data sharing and degree to which the infrastructure is being developed to provide integrated care management and a visit to a downstream partner to evaluate direct care delivery.  All Phase 1 and 2 site visits will be completed by April, Phase 3 site visits will begin in May.

4  Instructions and a template notification letter for Health Homes that need to make changes to their name, NPI number, or their provider network are available on the Health Home website.  Health Homes are responsible for taking other actions that may be required should they have a change in name, NPI or changes in their network partners. Examples of changes that may be required are executing new DEAAs or contracts, updating network partner lists to ensure accurate member assignments, or end dating records in the Member Tracking System.  Program materials, e.g., consent forms, brochures, websites, etc should be updated and uniformly reflect any changes in the Health Home program name.

 Health Home rates have been loaded for all phases for Health Home with Medicaid Provider IDs.  Health Home COBRA rates have been loaded for all phases.  Phase 2 and 3 Health Home OMH TCM and MATS rates have been approved and will be loaded onto provider files in the next few weeks. 5

 New assignment lists for Phase 1 and 2 counties were made available to Health Homes and Managed Care Plans in January  These lists supersede any previous lists that were released. They also include dual-eligible (Medicaid and Medicare) members.  Phase 3 lists will be released mid-March. 6

 Changes to Member Tracking System to simplify and streamline the process are expected to be in place by March 18.  The new member tracking system has been discussed during the Health Home and Managed Care Plan Member Tracking System weekly calls and a file layout was distributed to participants on that call.  If you have questions, send an to the Health Home mailbox at 7

 The Health Home Care Management Assessment and Reporting Tool (HH-CMART) was rolled out last week. This tool will collect dates and types of services delivered to Health Home members, for statistical purposes.  Weekly technical assistance calls are scheduled on Wednesdays from 10am-11am. Send an to the Health Home mailbox to sign up if you did not receive the invitation (use HH-CMART in the subject line).  Based on user feedback, the scope of data required to be submitted for 2012 interventions has been reduced.  The FACT–GP and Health Home Functional Assessment are still needed for 2012 data submission. 8

 Funding for Health Home Infrastructure Grants is still included in the State budget; funding will be delayed to April 2014 but the funding authority remains in the 2013 budget in the event funds become available earlier.  NYS will continue to pursue the infrastructure funding that was included in the CMS waiver.  A proposal to reimburse MCOs for Health Home administrative costs through the capitated rate is being considered as part of a package of MCO rate adjustments. 9

 A model for enhancing Health Home services for those in need of high intensity mental health care is under discussion with OMH. This model, known as Health Home Plus, will initially start in the metro area. Populations under discussion include Assisted Outpatient Treatment (AOT) individuals and those discharged from Psychiatric Hospitals.  DOH is applying to CMS for a demonstration project to evaluate the outcomes for dual eligibles enrolled in Health Homes; there is a potential for gainsharing in any Medicare savings achieved. 10

 Questions for the Health Home program can be ed to the Health Home Bureau Mail Log (BML) at  A new address will be distributed shortly; the user will be required to select a topic in order to send an . This will allow for more accurate distribution of Health Home inquiries to appropriate staff (currently this is done manually).  Hot topics from the BML will be featured on these webinars. 11

When will translated consent forms be available?  The Health Home Patient Information Sharing Consent Form (DOH- 5055) and the Health Home Withdrawal of Consent (DOH-5058) have been posted in English on the Health Home website. Translations are underway and will be available as soon as possible; they have been delayed due to the need to rebid the NYS contract for translation services.  The Health Home Opt-out Form (DOH-5059) must be signed by a current or eligible Health Home member if they do not want to receive Health Home services. This is available in English, Spanish, French, Russian, Chinese, Haitian Creole, Italian and Korean. 12

Does a provider have to be part of the Health Home Network to be listed on the Health Home Patient Information Sharing Consent Form DOH 5055?  The DOH-5055 is the consent by the member to share data with a list of providers. It does not matter if that provider is in the Health Home network officially or not. For example, the member may be seeing a specialist physician in another state or city for a very specific problem. This specialist would never be in the full Health Home network but would be part of the member's specific network for sharing of that member's PHI only as part of care management and coordination.  The Health Home could not share any other patient's information with that provider, only this member's. It is expected that the most commonly used type of partners would be in the Health Home, but some may not be. 13

What will the signed Health Home consent form allow? The signing of the Health Home consent form will serve two distinct functions.  It will allow the Health Home care providers to share member information;  It will allow the lead Health Home to access patient information directly from the local RHIO. 14

If member’s consent is not required to initiate Health Home services then why does a member need to sign a withdrawal of consent form (DOH-5058) which also states that the member no longer wishes to be a part of the Health Home?  Member disenrollment from a Health Home program prior to consent requires an opt out form (DOH 5059).  If a consent has already been signed, then a signed Withdrawal of Consent Form (DOH 5058) is required. 15

Does DOH have to approve referrals for Health Home services?  Potential members may be referred for Health Home services from any source, these are known as community referrals.  Members do not have to be on DOH lists or be approved by DOH in order to be accepted for Health Home referral. Health Homes and MCPs are responsible for determining whether the individual presumptively meets criteria for referral.  Health Home resources should be prioritized for the neediest members. Each Health Home can develop criteria for evaluating eligibility and need. Assessment for referral should include three steps. 16

STEP 1- ASSESS ELIGIBLITY: Must meet eligibility for Health Home Services as described in the New York State Health Home State Plan Amendment (claims data should be used whenever available to verify medical and psychiatric diagnoses) ◦ Two chronic conditions (e.g., mental health condition, substance use disorder, asthma, diabetes, heart disease, BMI over 25, or other chronic conditions; OR ◦ One qualifying chronic condition (HIV + or AIDS) and the risk of developing another; OR ◦ One serious mental illness. 17

STEP 2-ASSESS APPROPRIATENESS FOR HEALTH HOME: Has significant behavioral, medical or social risk factors which can be modified/ameliorated through care management including any of the following: ◦ Probable clinical risk for adverse event, e.g., death, disability, inpatient or nursing home admission ◦ Lack of or inadequate social/family/housing support ◦ Lack of or inadequate connectivity with healthcare system ◦ Non-adherence to treatments or medication(s) or difficulty managing medications ◦ Recent release from incarceration or psychiatric hospitalization ◦ Deficits in activities of daily living such as dressing, eating, etc ◦ Learning or cognition issues 18

Other factors to be considered to determine the suitability of Health Home services include a history of poor connectivity to care, including but not limited to:  No primary care practitioner (PCP)  No connection to specialty doctor or other practitioner  Poor compliance (does not keep appointments, etc)  Inappropriate ED use  Repeated recent hospitalization for preventable conditions either medical or psychiatric  Recent release from incarceration  Cannot be effectively treated in an appropriately resourced patient centered medical home  Homelessness 19

STEP 3 -INITIATE REFERRAL: If member meets criteria described in Steps 1-2, the referral can be made on the basis of this presumptive assessment. ◦ Referrals for FFS members are made to the lead Health Home, referrals for plan members can go directly to the MCP or to the lead Health Home to make the MCP connection. ◦ Health Homes and plans have access to assignment information in the HCS portal and should check an individual’s assignment status prior to making a referral. ◦ If the individual is already assigned to a Health Home, that Health Home should be contacted to discuss the appropriate course of action. ◦ Referrals are added to the Member Tracking System. 20

Can two downstream providers share information about a specific member with each other if each has a signed DEAA with the same lead Health Home, but the member has not yet signed a consent?  The DEAA allows for data exchange between the lead Health Home and DOH, the lead Health Home then signs Business Associate Agreements (BAAs) with network partners with which it will share information prior to obtaining member consent (these are referred to as subcontractors).  If two network partners have each signed a BAA with the same lead Health Home and member has not yet signed a consent form, the two partners cannot share data between them. Data agreements are for sharing between DOH and the Health Home and their network partners (aka subcontractors). 21

Do MCOs and Health Homes sign DEAAs as well or is the BAA signed and executed with the State Standard Contract enough to exchange Protected Health Information (PHI)?  MCOs are not required to complete DEAAs with the Department. The data they are accessing is for their own patients, who have enrolled with them, and given the MCO permission to share/exchange PHI.  The Health Homes and MCOs execute contracts, which will include a BAA that allows the MCO to share member PHI with the Health Home. 22

23 Questions?

 Visit the Health Home website: medicaid_health_homes/  Get updates from the Health Homes listserv. To subscribe send an to:  In the body of the message, type SUBSCRIBE HHOMES-L YourFirstName YourLastName  questions or comments:  Call the Health Home Provider Support Line: