Questions and Answers

Q & A Topics

General | Billing and Payment | Chronic Illness Demonstration Project (CIDP) | Health Home Design | Health Home Development Funds | Health Home Letter of Intent/Applications/Provider Enrollment/Application Form | Health Home Network | Health Information Technology | Managed Care | Member Forms | Population Assignment/ Eligibility (Patient Tracking System) | Quality Metrics and Evaluation (CMART) | Spend Down | Targeted Case Management (TCM) |

Health Home Design

1. All Medicaid participating hospitals will be required to have some sort of procedures for referring patients potentially eligible for Health Home services to Health Home providers. This applies regardless of whether the hospital participates in a Health Home network. Please confirm.

Yes, this is a requirement of the federal law authorizing Health Homes.

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2. There is a federal mandate for hospital Er´s that treat people with chronic issues to connect individuals to designated Health Homes. Who is educating the hospitals about this requirement?

On February 15, 2017, the Department issued, DHDTC DAL 17–04 – Hospital Requirements for Making Referrals to Health Home informing NYS hospitals of federal and state requirements that call for hospitals to refer Medicaid recipients who present in hospital emergency departments to Health Homes. The letter directed hospitals to provide assurance to the Department that policies and procedures were developed and implemented to support this requirement. The Department also issued Q&As to assist hospitals with this process.

General guidance on community referrals is included in the Health Home Provider Manual and in the April 2013 Medicaid Update Health Home Special Edition.

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3. Why are the Health Home leads so involved in the process of care coordination when they should be focused on an administrative role? Is it true that NYS has stated that Health Home Leads should be focused on outcomes rather than process?

Lead Health Homes are not only responsible for an administrative role, they are also delivering Health Home care management services directly and with network partners while making decisions about how the Health Home should operate. Although the State has posted several required forms and assessments, the State anticipates that Health Homes may have other forms and assessments they will want to use to standardize the provision of care management. The State has stayed away from proscribing process and will be holding Health Homes responsible for meeting quality measures. Health Homes have the flexibility to decide the processes and policies to achieve the best outcomes.

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