School Based Health Center (SBHC) Letter

Note: Benefit Transition Date Has Been Delayed

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

January 7, 2019

To maintain momentum for the January 1, 2021 School Based Health Center (SBHC) transition to Medicaid Managed Care (MMC), the New York State Department of Health (the Department) would like to ensure continued and documented progress on care coordination strategies that will facilitate a successful transition. The Department will build on the work accomplished to date and continue to engage with stakeholders toward completing the transition objectives.

Medicaid Managed Care Plans (MMC plans) and SBHCs are expected to continue to work cooperatively on the following measures to implement agreements that facilitate the sharing of SBHC patient level data to improve quality, outcomes, and care coordination. This collaboration should, at minimum, exist through the following actions:

  • Gap Report Sharing – The template gap report was provided to stakeholders during the SBHC carve–in meeting on August 24th, 2017. The gap report is a key instrument to improving care by providing member level data on preventive services a child has yet to receive. Once fully implemented , the SBHC will utilize the gap report to provide their roster to the MMC plan and the MMC plan will complete the report by providing service gap information back to the SBHCs for each child on the roster. Sponsoring Article 28 entities may facilitate the exchange of information for multiple SBHC sites. This report is essenti al in facilitating care coordination and MMC plans and SBHCs should work cooperatively to leverage contractual relationships or create administrative agreements needed to share service data for the children they serve. The gap report should be shared between MMC plans and SBHCs twice during the school year, beginning in 2019.
  • Contracting – School Based Health Centers and MMC plans should continue to implement provider agreements. The Department expects that MMC plans will resume submitting contract reports on a quarterly basis to the Department's Bureau of Managed Care Certification & Surveillance (BMCCS) BML: bmccsmail@health.ny.gov, with the next submission due on March 31, 2019.

The Department looks forward to our continued collaboration in implementing the SBHC transition to managed care. If you have any questions, please submit to: omcmail@health.ny.gov.

Sincerely,

Jonathan Bick
Director
Division of Health Plan Contracting and Oversight
Office of Health Insurance Programs

Lauren J. Tobias
Director
Division of Family Health