COVID-19 Guidance for Medicaid Providers

Guidance for Health Homes Serving Adults, Health Homes Serving Children/Youth, and Care Coordination Organization/Health Homes (CCO/HH) Related to COVID–19

  • Guidance is also available in Portable Document Format (PDF)

March 14, 2020

Re: COVID–19 Guidance for Health Homes

Dear Medicaid Health Homes Serving Adults and Children, Care Coordination Organization/Health Homes and Care Management Agencies:

The New York State Department of Health is providing this guidance to New York State Medicaid providers identified as Health Homes Serving Adults, Health Homes Serving Children/Youth, and Care Coordination Organization/Health Homes (CCO/HH), pertaining to the current novel coronavirus (COVID–19) outbreak.

Face to Face Requirements Waived for Health Home Care Management, Unless Medically Necessary

In response to concerns relating to the novel coronavirus (COVID–19) and in an effort to protect members and providers, effective immediately, the New York State Department of Health has authorized a temporary waiver of face–to–face requirements for Health Home providers, including Health Homes Serving Adults, Health Homes Serving Children, and Care Coordination Organization/Health Homes. This temporary waiver will remain in effect until it is rescinded by the Department of Health.

In lieu of face–to–face contact, care managers may utilize telephonic or telehealth capabilities. Health Homes and Care Management agencies should follow applicable NYS Telehealth Guidance. Health Homes may continue to bill at the applicable rate for members contacted via alternative means during the billing month.

When postponing face–to–face visits, care managers should carefully coordinate next steps with the member and other providers. If the member has immediate care management needs, for example, the member requires assistance with pharmacy or accessing food and other basic needs, the care manager should assure a frequency of contact sufficient to keep the member healthy and safe.

Background

The health and safety of Health Home Program staff and our ability to provide and support member care remain our priorities. Recently, community–wide transmission of COVID–19 has occurred in the United States (US), and the number of both Persons Under Investigation (PUIs) and confirmed cases are increasing in NYS. The situation with COVID–19 infections identified in the US continues to evolve and is very rapidly changing. It is important for all agencies to keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up–to–date information for healthcare providers.

Health Homes, Care Management Agencies´ and CCO/HHs management should keep staff updated as the situation changes and educate them about the disease, its signs and symptoms, and necessary infection control to protect themselves and the people they serve. The NYSDOH distributes alerts and advisories through the HCS notification system, and therefore it is vital that providers maintain up–to–date contact information in the HCS Communications Directory. Agencies may wish to provide internal contact information for their staff and clients to call with concerns, reports or questions.

Criteria for screening members prior to conducting a Face–to–Face Visit

While the health home face–to–face requirements have been waived during this time, in certain instances, face–to–face may still prove to be clinically indicated. Prior to conducting a face–to–face visit, the care manager should screen the member using the following questions:

  1. Ask whether the member has a fever, cough or shortness of breath.
  2. Ask the member, "Have you, or has someone with whom you have had close physical contact, traveled out of the United States within the last 14 days?"
  3. (If yes) "To which countries did you/your contact, travel?" For updated information on affected countries visit here.
  4. Ask the member, "Within the last 14 days, have you had contact with any person(s) under investigation (PUI) for COVID–19, OR with any person(s) known to have COVID– 19?"
  5. If the member screens positive in response to any of these questions, the care manager should coordinate with the member and appropriate health care providers to ensure that the member is referred to the appropriate medical personnel.

    If the member does not screen positive in response to any of these questions, the face–to–face visit may proceed.

    Instructions for agency personnel who are at risk of being a Person Under Investigation (PUI)

    Health Home staff are exposed to the general community each day and could become infected with an acute respiratory illness (e.g. COVID–19, influenza, respiratory syncytial virus (RSV)), if community transmission of that illness is occurring. Agencies should ensure they have a policy in place to speak with staff prior to them conducting face–to–face visits with enrolled members in order to screen the staff for symptoms or contacts that might have put them at risk. It is important that agencies strictly enforce their illness and sick leave policies. Staff showing symptoms of illness should not be permitted to remain at work or visit members and should not return to work until completely recovered.

    Health Home staff persons who have been potentially exposed to someone with confirmed COVID–19, or to someone who is a person under investigation (PUI) for COVID–19, might be placed under movement restrictions by public health officials, based on exposure risk for having contracted COVID–19 and any presenting symptoms.

    If a Health Home staff person is found to be ill upon screening, the agency should send the person home and suggest that they contact their primary care physician immediately or refer them to immediate medical care, if indicated.

    Where can I direct my questions about COVID–19?

    Questions can be directed to the following email address: icp@health.ny.gov; or to the toll–free call center at 888–364–3065.

    Your diligence in implementing appropriate measures for COVID–19 preparedness is appreciated.

    Where can I direct my questions about this guidance?

    Please send any questions relating to this guidance to HHSC@health.ny.gov or HHIDD@health.ny.gov.

    Your diligence in implementing appropriate measures for COVID–19 preparedness is appreciated.

    Sincerely,

    Gregory Allen
    Director, Division of Program Development and Management
    Office of Health Insurance Programs