Health Home Policy and Updates

This page has been organized by policy topic and includes both policy and procedures, as well as guidance documents issued by the Department. Please check back here frequently for updates.

*Note that the current policy manual remains effective until otherwise noted.

Background Checks

  • Background Check Requirements for Health Homes and Care Managers #HH0010 - (Web) - (PDF) - Revised February 2021
  • Mandatory Background Check Requirements for HCBS Providers and Health Homes - (PDF) - Slides revised April 2019
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Billing

  • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (Web) - (PDF) - November 2023
  • Medicaid Managed Care Plan Billing and Payment Protocol for Health Home Services - (Web) - (PDF) - Effective: July 1, 2018, Revised: March 2019
  • Coverage Code Compatibility with the Health Home Program - (Web) - (PDF)
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  • Access to/Sharing of Personal Health Information (PHI) and the Use of Health Home Consents #HH0009 - (PDF) - Updated May 1, 2022
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Eligibility

  • Health Home Notices of Determination and Fair Hearing Policy #HH0004 - (Web) - (PDF) - Updated April 2022
  • Eligibility Requirements for Health Home Services and Continued Eligibility in the Health Home Program HH0016 - (Web) - (PDF) - October 2023
    • Guidance for Use of the Continued Eligibility for Services (CES) Tool - (Web) - (PDF) - October 2023
      • DOH - Health Home Continued Eligibility for Services (CES) Tool - (PDF) - Updated December 2023
      • DOH - Health Home Continued Eligibility for Services (CES) Review Tool - (XLSM) - Updated December 2023
      • Appropriateness Criteria Codes HHSA & HHSC - (Protected Excel)
      • Appropriateness Criteria Codes HHSA & HHSC - (Web)
      • DOH Health Home Program Office Hours Q&As - (Web) - (PDF) - September 6, 2023
      • NYS DOH Initial Appropriateness and Continued Eligibility for Services (CES) Tool training slides - (PDF) - Updated December 2023
      • Health Home Initial Appropriateness and Continued Eligibility for Services (CES) Tool: Frequently Asked Questions (FAQ) - (PDF) - December 2023
  • Assertive Community Treatment and Health Home Updated Instruction - (Web) - (PDF)
  • Definition of Serious Mental Illness for Health Home Eligibility - (Web) - (PDF)
  • Updated Guidance for FIDA and Health Home - (Web) - (PDF) - Effective January 1, 2018
    • Desk Aid for Identifying FIDA, PACE, and FIDA IDD Members - (PDF)
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General Health Home

  • Program Guidance - Health Home Care Management for People Living with HIV and Persons at Risk for HIV - - revised August 2022
  • Comprehensive Assessment Policy #HH0002 - (PDF) - Updated May 1, 2022
  • Member Disenrollment From the Health Home Program Policy #HH0007 - (PDF) - Updated May 1, 2022
  • Transfer Process Between Health Homes and Waiver Programs for Care Management Services - (PDF) - Updated April 2022
  • MAPP HHTS Segment End Date Category & Reason Codes Crosswalk and Guidance Chart - (PDF) - April 2022
  • COVID-19 Guidance for Health Homes - (PDF) - March 2020
  • COVID-19 Guidance for Children's Waiver Services Providers - (PDF) - March 2020
  • Health Home Care Management Activities and Billing Protocols for Managing Newly Referred Individuals from Excluded Settings #HH0011 - (PDF)
    • 1915(c) Children's Waiver and 1115 Waiver Amendments Webpage - (Web)
  • Health Home Plan of Care Policy #HH0008 - (Web) - (PDF) - Updated May 1, 2022
  • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) - Updated March 4, 2019
  • DHDTC DAL 17-04 - Hospital Requirements for Making Referrals to Health Home - (PDF)
  • DHDTC DAL 17-04 - Hospital Requirements for Making Referrals to Health Home - Questions and Answers - (PDF) (posted May 2017)
  • Monitoring the Reporting of Complaints and Incidents - (PDF)
  • Recipient Restriction Program (RRP) - (PDF)
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HARP and Adult BH-HCBS

  • Adult Behavioral Health Home and Community Based Services (BH HCBS) Guidance for HARP and HIV SNP Members Enrolled in Health Home - (PDF) - January 2022
  • Billing Guidance for the Administration of the NYS Eligibility Assessment for Behavioral Health Home and Community Based Services (BH HCBS) and the NYS Community Mental Health Assessment (Webpage)
  • Community Mental Health Assessment Billing Procedures
    • Community Mental Health Assessment Billing Procedures - (PDF)
    • Updated Staff Qualifications to Serve Health Home Plus (HH+) SMI and Assessor Qualifications for Administering the NYS Eligibility Assessment (NYS EA) for Adult BH HCBS - (PDF)
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Health Home Serving Children (HHSC)

  • HHSC Eligibility, Appropriateness, Prioritization and 6 Core Services - (PDF) - (PDF) - March 2022
  • Eligibility Process, Policy and Chronic Conditions - (PDF) - March 2022
  • Complaint and Grievance Policy for Health Homes Serving Children #HH0013 (HHSC Only) - (PDF) - Effective April 1, 2021
  • Conflict Free Care Management Policy #HH0012 (HHSC Only) - (PDF) - Updated: May 2020
    • Policy Revision Overview - for CFCM policy #HH0012 - (PDF) - Updated: May 2020
  • Health Home Program Chronic Condition Update with Developmental Disabilities Conditions - (PDF)
  • UPDATE Guidance Regarding RE Code 23 OMH HCBS Waiver Stepping Down to Health Home - (PDF)
  • HHSC Additional Guidance Regarding Program Referrals and Enrollment - (PDF) - Effective March 29, 2017 updated June 1, 2017
  • Referring Children in Foster Care and linking them to a Non-Voluntary Foster Care Agency (non-VFCA) Health Home Care Management Agency (HH CMA) - (PDF)
  • Approved Reasons and Processes to Correct CANS-NY Errors within the UAS-NY - (PDF)
  • Guidance Regarding Health Home Governance Fees and Payment Structures - (PDF) - October, 2016
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Outreach

  • Elimination of Health Home Billing for Outreach - (PDF) - Effective: July 2020
    • Elimination of HH Outreach Billing: Impact on the MAPP HHTS - (PDF) - Effective July 1, 2020
  • Interim Guidance Addressing Outreach Modifications - (PDF) - October 2017
  • Health Home Outreach Reprogramming - (PDF) - October 2017
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Performance and Quality Management

  • Health Home Quality Management Program #HH0003 - (PDF)
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Reportable Incidents

  • Health Home Monitoring: Reportable Incidents Policies and Procedures #HH0005 - (PDF) - Revised April 2021
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Sharing Protected Health Information (PHI)

  • HARP/Sharing Protected Health Information for Outreach to support Enrollment of Individuals in Health Homes - (Web) - October 2015
  • Guidance for Sharing Protected Health Information for Outreach by Health Homes Frequently Asked Questions - (Web) - (PDF) - October 2015
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  • DOH - Health Home Continued Eligibility for Services (CES) Tool - (PDF) - Updated November Archived December 2023
  • DOH - Health Home Continued Eligibility for Services (CES) Review Tool - (XLSM) - November Archived December 2023
  • NYS DOH Initial Appropriateness and Continued Eligibility for Services (CES) Tool training slides - (PDF) - Updated November 9, 2023 Archived December 2023
  • Health Home Initial Appropriateness and Continued Eligibility for Services (CES) Tool: Frequently Asked Questions (FAQ) - (PDF) - November 2023
  • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (PDF) - July 2023
  • Appropriateness Criteria Codes HHSA & HHSC - (Protected Excel) Archived November 2023
  • Health Home Eligibility Policy - (PDF) - Updated March 2022 Archived October 2023
    • Eligibility Requirements: Identifying Potential Members for Health Home Services Appropriateness Criteria (HHSA Only) - (PDF) - September 2020 Archived October 2023
    • NYS DOH Initial Appropriateness and Continued Eligibility for Services (CES) Tool training slides - (PDF) - November 2023
    • NYS DOH Initial Appropriateness and Continued Eligibility for Services (CES) Tool training slides - (PDF) - October 2023
    • DOH - Health Home Continued Eligibility for Services (CES) Tool - (PDF) - Sept 2023
    • DOH - Health Home Continued Eligibility for Services (CES) Review Tool - (XLSM) - Sept 2023
    • Comprehensive Assessment Policy #HH0002 - (PDF) - May 2022
    • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (PDF) - April 1, 2022
    • Member Disenrollment From the Health Home Program Policy #HH0007 - (PDF) - December 17, 2021
    • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (PDF) - February 2021
    • Transfer Process Between Health Homes and Waiver Programs for Care Management Services - (PDF) -
    • Conflict Free Care Management Policy #HH0012 (HHSC Only) - (PDF) - February 2020
    • Health Home Plan of Care Policy #HH0008(PDF) - (PDF)
    • Health Home Monitoring: Reportable Incidents Policies and Procedures #HH0005 - (PDF) - Revised October 2019
    • Access to/Sharing of Personal Health Information (PHI) and the Use of Health Home Consents #HH0009 - (PDF) - June 2019
    • Comprehensive Assessment Policy #HH0002 - (PDF) - Updated June 30, 2019
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - April 2019
    • Member Disenrollment From the Health Home Program Policy #HH0007(PDF) - (PDF) - March 4, 2019
    • HHSC Eligibility, Appropriateness, Prioritization and 6 Core Services - (PDF) - February 2019
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - February 2019
    • Comprehensive Assessment Policy #HH0002 - (PDF)
    • Billing and Documentation Standards for Health Home: High, Medium, and Low (HML) Rates with Clinical and Functional Adjustments(PDF) - (PDF)
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - November 30, 2018
    • Member Disenrollment From the Health Home Program Policy #HH0007 - (PDF) - November 1, 2018
    • MAPP Segment End Date Reason Codes Crosswalk - (PDF) - Effective: October 31, 2018
    • MAPP Segment End Date Reason Codes Guidance Chart - (PDF) - Effective: October 31, 2018
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - August 31, 2018
    • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) - Updated August 22, 2018
    • Background Check Requirements for Health Homes and Care Managers #HH0010 - (PDF) - April, 1, 2018 (PDF)
      • CHRC Extension Announcement - (PDF) - April 2019
      • Background Check Guidance for HCBS Providers - (PDF) - November 2018
    • Health Home Notices of Determination and Fair Hearing Policy #HH0004 - (PDF) - November 2017
    • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) and FAQs - (PDF) - Both updated November 15, 2017
    • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) - Updated October 25, 2017, and FAQs - (PDF)
    • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) - October 1, 2017
    • Adult Behavioral Health and Community Based Services (BH HCBS) - (PDF) - October 1, 2017
    • Health Home Monitoring: Reportable Incidents Policies and Procedures #HH0005 - (PDF) - July 2017
    • Health Home Monitoring: Reportable Incidents Policies and Procedures and Reporting Timeframes #HH0001 - (PDF) - Superseded by policy #HH0005
      • Reportable Incident Reporting Guidance for Health Homes - (PDF)
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - March 3, 2017
    • Monitoring Surveys - (PDF)
    • Eligibility Requirements: Identifying Potential Members for Health Home Services - (PDF) - April 23, 2014
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