State Administrative Health Home Service Agreement (ASA) Letter

  • Letter is also available in Portable Document Format (PDF, 876KB)

March 8, 2016

Dear Managed Long Term Care Plans and Health Homes:

As you may be aware, in New York City, Managed Long Term Care Plans (MLTCPs) and Health Homes have engaged in a partnership designed to carry out activities related to a legal settlement in relation to seriously and persistently mentally ill residents of adult care facilities (commonly called DAl2).

At this time, the Department of Health´s Office of Health Insurance Programs (OHIP) is requiring MLTCPs to ensure access to Health Homes on a statewide basis. We recommend that MLTCPs execute Administrative Health Home Service Agreements (ASAs) with as many Health Homes in their service areas as is practical to achieve this access requirement. To facilitate formalizing such arrangements, OHIP has developed the four documents below:

  1. Statewide Administrative Health Home Services Agreement Between Managed Long Term Care Plan and Health Homes;
  2. Statement and Certification;
  3. Guidance for Providing Care Coordination and Management to Medicaid Members Enrolled in MLTC Plans and Health Homes; and
  4. Care Planning and Coordination for MLTC Plans and Health Homes form.

Please note that neither the ASA nor the Statement and Certification should be altered. The Care Planning and Coordination document was developed as a part of the DAl2 collaboration and is a recommended vehicle to promote successful Health Home and MLTC care planning partnerships.

Programs of All- Inclusive Care for the Elderly (PACE) are required by federal regulation to provide consumers with an interdisciplinary team approach to develop person-centered care plans and to provide ongoing care management; therefore, this does not apply to PACE.

If your plan has any questions about implementing the type of collaboration described above, please contact your Department of Health Managed Long Term Care plan manager or, for Health Homes, Jane Colon in the Division of Program Development and Management at


Mark L. Kissinger
Director, Division of Long Term Care
Office of Health Insurance Programs

Gregory S. Allen, Director
Division of Program Development & Management
Office of Health Insurance Programs