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Health Homes: SPA 11-56 Application Process . August 17, 2011 10:00AM. New Requirements. New DEADLINE for Health Home Applications: October 3, 2011 Letters of Intent Due COB September 1, 2011 Health Homes implementation – November 1, 2011. Letter of Intent (LOI).

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Health Homes: SPA 11-56Application Process

August 17, 2011

10:00AM


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New Requirements

  • New DEADLINE for Health Home Applications: October 3, 2011

  • Letters of Intent Due COB September 1, 2011

  • Health Homes implementation – November 1, 2011


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Letter of Intent (LOI)

  • Due to numerous requests, the Health Home application deadline has been extended to COB October 3, 2011.

  • Prospective applicants must submit LOI, as an attachment (e.g. Word) by COB September 1, 2011 to [email protected] with a subject line that begins with: "LOI for HH".


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Letter of Intent (cont’d.)

  • Letters of Intent must include:

    • The host or primary applicant;

    • A preliminary list of the proposed Health Home network/partners including direct care providers, TCM, COBRA, MATS, CIDP programs, and CBOs;

    • Proposed service area; and

    • Initial capacity, that specifically identifies the number of current TCM/COBRA, MATS, or CIDP slots, if applicable, that will become part of the proposed Health Home, as well as the number of new (not already in any care management) health home slots by service intensity (low, intermediate, high) that the proposed Health Home is prepared to accept as assignments this fall.


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Application Overview

  • Application and detailed instructions are available at:

    http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/

  • Application is due by COB October 3, 2011

  • Health Homes implementation November 1, 2011.

    • SPA approval date

    • Patient assignment

    • Health Homes can bill for health home services


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Application Overview (cont’d.)

Applicant Information:

  • This is information specific to the ‘host’ or ‘lead’ applicant.

  • This is the entity that will have a contract with NYS to provide Health Home services and be responsible for reporting on and meeting the health home quality measures.


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Application-Section A Overview

SECTION A:

HEALTH HOME PROVIDER SPECIFIC INFORMATION

  • Opportunity to describe the proposed Health Home

  • Answers limited to 1000 characters, present outline of health home elements including:

    • The experience that the assembled network has in providing integrated care

    • Professionals and other team members to be used

    • Means of identifying low, intermediate and high care management as defined by the Health Home

    • Actions the Health Home will use when intervening in a crisis , as well as to prevent crisis for its members

    • Ability to meet or plan to meet HIT standards


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Application- Section B Overview

Section B: Health Home Provider Network & Program Capacity

  • It is not possible for a single entity to meet all of the health home provider qualification standards without partners

  • Applications lacking partners will not be approved

  • Section B focuses on the proposed network which must include physical, behavioral health and community support partnerships.

    • It is expected that Health Home applications will include partnerships with one or more TCM/COBRA, MATS, or CIDP program.


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Application- Section B Overview

  • Identify each network provider organization, as well as associated individual practitioners for each of the locations.




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Application-Section C Overview

Section C: ATTESTATION

Part IHealth Home Program Requirements

  • Health Home applicant must attest that their Health Home will provide:

    • Coordination of care and services post critical events, such as emergency department use, hospital inpatient admission and discharge;

    • Language access/ translation capability;

    • 24 /7 telephone access to a care manager;

    • Crisis intervention;

    • Links to acute and outpatient medical, mental health and substance abuse services;

    • Links to community based social support services-including housing; and

    • Beneficiary consent for program enrollment and for sharing of patient information and treatment.


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Application-Section C Overview (cont’d.)

  • Health Home Applicant must attest that contractual agreements (or other agreements as practicable) are in place with all organizations included in the provider network.

  • NYS will not review these contracts nor provide a template.

  • Each Health Home must determine what needs to be included in the contract. If there will be no exchange of money between the health home and another entity, health homes, may elect to enter into another type of linkage agreement (e.g. MOU)


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Application-Section C Overview (cont’d.)

Part II. Health Home Provider Qualification Standards

  • Applicant is attesting that the Health Home can meet the Core Health Home Requirements

    • Comprehensive Care Management

    • Care Coordination and Health Promotion

    • Comprehensive Transitional Care

    • Patient and Family Support

    • Referral to Community and Social Support Services

    • Use of (HIT) to link services

    • Quality Measure Reporting to NYS


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Application-Section C Overview (cont’d.)

Applicant is attesting the Health Home can meet the CMS Health Home Provider Functional Requirements

  • Health Home Applicants must submit a written attestation that the services specified will be provided in accordance with the following health home functional components referenced in the CMS State Medicaid Director’s Letter, 10-024 (https://www.cms.gov/smdl/downloads/SMD10024.pdf):


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Application-Section C Overview (cont’d.)

Part III. Rights of the State

  • NYS reserves the right to assign beneficiaries to a specific health home.

  • NYS reserves the right to cancel a Health Home provider’s approved status based on failure to provide health home services in accordance with the NYS Health Home Provider Qualification Standards, provide quality health home services to clients, or upon other significant findings determined by the State.

  • NYS reserves the right to cancel the program at any time for lack of funding, if, after evaluation of the program desired results in quality, efficiency and decreased costs are not shown, or for any other reason determined by NYS.


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Patient Attribution

  • The State will use a combination of the following to assign Medicaid enrollees to Health Homes:

    • clinical risk groups (CRG),

    • an algorithm that predicts hospitalizations, and

    • behavioral health indicators

  • Medicaid enrollees will be assigned to a health home, to the extent possible, based on existing relationships with ambulatory, medical and behavioral health care providers or health care system relationships, geography, and/or qualifying condition.

  • Initial assignments will be for members who qualify for Health Home services but currently do not have a meaningful primary care or case management connection.

  • Patients will not be moved from their current TCM/COBRA, CIDP, MATS


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Patient Attribution (cont’d)

  • The State will also like to include any supportive housing services an individual may have in keeping those connections in health home assignments.

  • Once assigned, enrollees will be given the option to choose another provider when available, or opt out of health home enrollment.

  • The State will provide health home providers a roster of assigned enrollees and current demographic information to facilitate outreach and engagement.

  • With the exception of TCMs, where special arrangements may be made, Medicaid members enrolled with plans will be assigned into Health Homes by the plan utilizing loyalty and attribution data provided by the state.


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Questions?

  • Join the Health Home Listserv and get updated health home information. Go to: http://nyhealth.gov/health_care/medicaid/program/medicaid_health_homes/index.htm.

  • Questions or comments regarding NYS implementation of Health Homes can be directed to [email protected]


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