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Health Home Implementation Webinars

Learn about the integration of Assertive Community Treatment (ACT) program with Health Homes, including enrollment and billing statistics, housing updates, and Works in Progress. Understand the goals and benefits of Health Homes and the reimbursement process.

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Health Home Implementation Webinars

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  1. Health Home Implementation Webinars Session #31– January 8, 2014 Program Updates

  2. Agenda • ACT and Health Home Integration • Health Home Enrollment and Billing Statistics • Housing Update • HARPs/BHOs and Health Homes • Works in Progress: Other Updates

  3. ACT AND HEALTH HOMES Assertive Community Treatment Program (ACT) Joining Health Home Networks

  4. ACT Will Join Health Homes • ACT will be part of Health Home networks, which will have benefits for ACT recipients • This required DOB approval of a $50 rate increase to support ACT recipients in Health Homes

  5. ACT Will Join Health Homes • ACT must enter into provider contracts with Health Homes • ACT programs may contract with more than one Health Home • Contract is needed so that – • Funds can flow from the ACT Program to the Health Home, and • The Health Home can make its network available to ACT recipients who have signed a Health Home consent form

  6. ACT Will Join Health Homes • Health Homes must also execute a Data Exchange Application and Agreement (DEAA) Subcontractor Packet agreement with ACT programs • DEAA allows ACT and the Health Home to share information provided by DOH to the Health Home, prior to obtaining the ACT recipient’s consent: the last five claims and other member demographic information

  7. ACT Will Join Health Homes • ACT teams must now begin assigning Medicaid eligible ACT recipients into Health Homes using the Health Home’s Member Tracking • ACT and Health Homes must have an executed DEAA in order to transmit patient information

  8. What are the goals and benefits? • Health Homes will provide individuals access to a wide network of health providers • All of an individual's caregivers communicate with one another to address his or her needs in a comprehensive way • ACT teams will be able to more easily access step down care management at discharge

  9. Benefits of Health Homes • Monitor and provide linkage to all the network services an individual needs to stay healthy • Reduce emergency room, inpatient hospital and long term care facility use • Improve health outcomes for populations • Reduce Costs • Continuity of care within the Health Home environment • Improve flow through the ACT program

  10. Reimbursement • DOH approval is final. eMedNY will begin re-adjudicating ACT claims back to July 1, 2013 • ACT programs were notified of rate increase on December 6, 2013 • Claims may be re-processed prior to ACT executing contract with the Health Home

  11. Fiscal • Programs will receive retroactive increase in the monthly reimbursement, July 1 through the present. Increase is to be used for costs of preparing infrastructure, new IT and recordkeeping requirements, etc. • When ACT recipients are enrolled in Health Homes, ACT teams will forward $30 of the $50 increase to the Health Home as an administrative fee. The ACT program will retain the $20 balance for the new responsibilities and additional costs associated with being part of a Health Home

  12. Assignment & Enrollment • ACT should determine whether all current ACT recipients with active Medicaid are already assigned to or enrolled in a Health Home • If an ACT recipient is already enrolled, contact the Health Home and inform them that ACT is providing the care coordination (requires a executed DEAA)

  13. Assignment & Enrollment, Con’t. • To assign ACT recipients with active Medicaid, complete and submit member tracking information to the Health Home(s) in the format the Health Home requires (requires a completed DEAA) • To enroll ACT recipients who have signed a Health Home consent form, indicate on the Health Home’s Member Tracking that the individual is in active care management

  14. Enrollment Forms • ACT must work with recipients to secure consent to participate in the Health Home program (Health Home Patient Information Sharing Consent Form, DOH-5055) • ACT is responsible for helping ACT recipients understand and complete the form • The Health Home Consent Form allows the Health Home network partners listed on the form to share appropriate information to assist the member

  15. Health Home Assessment • ACT Programs must ensure that a FACT-GP and the HH Functional Assessment are completed for all ACT recipients when they enroll in a Health Home, annually, and when they disenroll • ACT will return the FACT-GP to the Health Home(s)

  16. Reimbursement • Populate the Direct Biller field of the Patient Tracking Form with the value of “Y.” This indicates to the Health Home that the downstream care management agency – in this case the ACT Program – bills eMedNY directly for services • The rate increase will be effective as of July 1, 2013 (July 31, 2013 billing)

  17. Reporting • In addition to the member tracking information, Health Homes require a single plan of care documenting the care management activities for individuals who have signed a Health Home consent • ACT teams must document care management activities in the Health Home single plan of care, and provide at least one Health Home Care Management service per month • It will be up to the ACT Team and the HH to develop a system of communication

  18. Next Steps for ACT & Health Homes • Execute DEAA and contract between ACT and Health Home(s) • ACT begin assigning ACT recipients into Health Homes by completing and transmitting Member Tracking information in whatever format the Health Home requires. Only demographic information may be shared prior to obtaining a signed consent form • When ACT recipients sign the Health Home consent, indicate that the recipient is in active care management in the Health Home’s Member Tracking

  19. Next Steps for ACT & Health Homes • Complete Health Home FACT-GP and Health Home Functional Assessment and submit to the Health Home • ACT is required to work with the Health Home to provide information needed by the Health Home • Member Tracking • Health Home FACT-GP and • Health Home Functional Assessment • Health Home Care Management record

  20. Health Home Update

  21. Health Home Enrollment Statistics As of December 26, 2013 there were about 74,000 members in Health Home Tracking System (50,000 active care management/24,000 in outreach)

  22. Health Home Claims Exceeds $179 Million

  23. Tracking System vs. Paid Claims • Statistics on numbers of members in the tracking system as compared to paid claims were shared with each Health Home. • Follow-up c alls were made to individual Health Homes to help them identify and correct discrepancies. • OMH TCM programs were given until the end of December 2013 to populate the tracking system for their respective Health Homes. • Once the OMH TCM programs have completed these submissions, the Tracking System data will be used to match members to paid claims so that OMH TCM claims can be reprocessed. • The tracking system vs. paid claims statistics will then be refreshed and shared with Health Homes.

  24. Health Homes and Housing • MRT Supportive Housing Health Home Pilot Program RFA expected to be released in early February • RFA will seek applications from Supportive Housing Providers for funds to provide rental subsidies and/or on site community based services to provide housing for homeless or unstably housed Medicaid members enrolled in Health Homes • Supportive Housing Applicants will required to identify and receive commitment of one or more designated Health Homes to be the Provider’s partner in implementing the RFA funds

  25. HARP and Behavioral Health Transition • A webinar was held and an RFQ has been released to provide an opportunity for stakeholders to submit questions about the HARP benefit plan. Deadline to submit questions has been extended to January 17. • The State submitted a Behavioral Health 1115 Waiver Amendment to CMS on December 30, along with a response to 106 questions posed by CMS based on preliminary discussions. This amendment will amend the State’s Partnership Plan to authorize the expansion of Behavioral Health services into Managed Care. • The RFQ and Behavioral Health Waiver amendment materials are posted at the link below (click on the link and then on the Behavioral Health Transition tab on the left) • http://www.health.ny.gov/health_care/medicaid/redesign/

  26. Works in Progress • Briefings have been provided to NYC-based Health Homes and MLTC plans that will be participating in the first stage of transitioning Adult Home residents to the community. • Continued discussions/work with stakeholders on: • Models for enrollment of Children in Health Homes. • Development of Health Home Plus, an enhanced model for AOT and other high-intensity populations. • Best Practice Guidelines for Hospitals to Develop CMS required referral process to Health Homes • Clarifying Health Home policies and procedures on eligibility and MLTC/HH enrollment

  27. Questions?

  28. Useful Contact Information • Visit the Health Home website: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/ • Get updates from the Health Homes listserv. To subscribe send an email to: listserv@listserv.health.state.ny.us(In the body of the message, type SUBSCRIBE HHOMES-L YourFirstName YourLastName) • To email Health Homes, visit the Health Home Website and click on the tab “Email Health Homes” http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/ • Call the Health Home Provider Support Line: 518-473-5569

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