NYS Medicaid State Plan Amendment (#11-56) Approved for Phase 1

February 6, 2012

We are extremely happy to report that New York's Medicaid State Plan Amendment (SPA 11-56) for Phase I Health Homes, with an effective date of January 1, 2012, for Medicaid Members with Behavioral Health and Chronic Conditions was approved.

What this means and next steps:

  • The State will work with existing care management (i.e. TCM, COBRA) programs to bill for patients they are already serving under Health Homes retroactive to January 1, 2012 - specific guidance on this process will be coming shortly from the Department of Health (DOH), the New York State Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services ( OASAS) - no changes to billing should happen until this guidance is released - please continue to bill for TCM as you are doing now; Phase I Provider-led Health Homes and their partners will immediately begin to consent patients already being served in care management programs (i.e., TCM and COBRA) to the Health Home program (the Health Home consent document is available on the Health Home website under Forms);
  • Provider-led designated Health Homes will get lists of new Health Home Eligible Fee-for-Service Members to enroll into Health Homes in February and may begin outreach and engagement at that time. Outreach and Engagement to members on the lists commencing in February should be billed for in March, using a February 1 date of service. Please see HH website for billing instructions in last webinar:
  • Managed Care Plans are working on contracts with Provider-led Health Homes to allow Managed Care Plans to assign their members into Health Homes as appropriate - Managed Care member assignment into Phase 1 Provider-led health homes will likely commence in March.

A detailed Medicaid Update Article is being prepared and will be posted on the health home website very shortly. As more information becomes available it will be posted to the website and shared during our next Webinar.