Health Home Update August 2012

On Aug. 1st, the NYS DOH Health Home workgroup held a conference call to discuss the implementation status of the NYS Health Home Initiative. This event was the second of a new series of bi-weekly conference calls designed to share updates with member providers and other interested parties affected by the DOH Health Home initiative, and to offer an opportunity to address questions. These calls were initiated by the Health Home workgroup, which includes members from multiple state agencies participating in the initiative. The following are some highlights from this and the first call, which was held on July 18th.

Functional Assessment Rollout

• For all individuals assigned to a Health Home, a FACT-GP and HH Functional Assessment must be completed at enrollment, annually, and at disenrollment. The results of these assessments must be submitted to DOH via the Health Home CMART tool that will be released by the DOH. These results will be used to adjust the risk scoring for members and, through that, the applicable rates.
• It is recognized that these are snapshot assessments and will not provide adequate information for care managers to make informed clinical decisions. Providers are encouraged to conduct more comprehensive assessments and use all resources that are available for that member to ensure the most appropriate care management plan is formulated. There are a number of tools, such as the DLA Assessment and SBIRT, available for use.

Consent 

• Consent forms allowing members to share information must be obtained from all individuals assigned to a Health Home.
• For individuals who refuse to sign a consent form, Health Homes must decide whether and how they can deliver quality Health Home services and care coordination without consent, and for how long. The process for how Health Homes will work with the RHIOs in these cases is being reviewed and refined.

Status of Phases 2 and 3

• Phase 2 Health Homes have been announced.
• Most of Phase 3 has been announced with a few more to be announced when details with each are worked out.
• The State Plan Amendment is for Phase 2 and 3 is not yet approved but DOH is working with CMS to answer questions and move the approval process along.
• The implementation date is still July 1st, but that mainly pertains to the conversion of TCM programs until the State Plan Amendment is approved.

Health Home Patient Tracking System

• The purpose of the Health Home Patient Tracking System is to facilitate communication between the NYS DOH and the Health Home Data Management Providers (DMP) regarding the status of Medicaid members eligible for Health Home services. DMPs must compile the Health Home information they receive from downstream providers into a single Patient Tracking file and submit that file to DOH. Such files must be processed before a claim is submitted, so it is crucial that the data be submitted promptly and accurately. Claims without properly submitted Health Home assignments will be denied for payment.
• The OHIP Datamart Portal is an application housed in the Health Commerce System (HCS) that will allow the download and upload of fixed-length text files by DOH and DMP.

We will continue to monitor the implementation of Health Homes and all phases of the Medicaid Redesign efforts. Keep checking back for new updates and additional information.