Health Homes and Children - Questions and Answers
Table of Contents
- Outreach, Engagement and Referrals
- Eligibility and Enrollment
- Health Home Design
- Billing and Payment
- Member Consent
1. What information is presently available on the Health Home website regarding children?
The draft Health Home Application to serve children was posted for comment on June 30, 2014 for prospective Health Homes seeking to be designated to serve children. The State is presently seeking comments on the draft Application prior to the formal application period which begins on August 30th.
The following information is available on the Health Home website; this information will be added to and updated:
- The draft Health Home Application to serve children
- Form to submit comments on the draft application
- Form to submit a letter of interest; for organizations that may wish to apply (Note: this letter is not mandatory and is non-binding)
- NYS model for Children’s Health Home
- Draft list of NYS providers with expertise in serving children
- List of volunteer Foster Care Agencies in NYS as of June 2013
- Various resources such as webinar notes and power point presentations
2. How will I know who is applying to become a Heath Home designated to serve children in my area/region?
Letters of Interest submitted from organizations interested in applying to be designated as Health Homes to serve children will be posted on our web site. Please visit our web site for any questions or concerns, as the Department will update information regularly.
3. Will there be multiple Health Homes serving each county/region?
The goal of the State is to designate qualified Applicants to provide Health Home services for children to ensure access and services for all children who are eligible for Health Home in New York State. Continue to check our web site for more information about providers as it develops. It is the expectation that Health Homes designated to serve children will serve a broader geographic area than the current designated Health Homes.
4. How do potential Health Home providers access the funds for Health Information Technology (HIT) initiatives?
ANSNew York has finalized terms and conditions with the federal government for a waiver amendment to the NYS Partnership Plan that will allow the State to reinvest $8 billion in federal savings generated by Medicaid Redesign Team (MRT) reforms. Included in this funding is $190.6 million of resources for Health Home development to support health information technology, governance, workforce training and retraining, and member engagement and health promotion. Information about additional opportunities for HIT funding can be obtained from the Regional Extension Center (REC) serving your region. For more information on HIT resources and how to contact your regional REC, visit the HealthIT.Gov website at: WER
5. Will the State develop a list of HCBS Waiver providers?
Attachment D: Draft List of Providers with Expertise Serving Children, will be expanded to include a more complete list of current 1915(c) HCBS providers.
6. How will the CANS-NY be administered? Will certification be necessary?
Modifications are being explored to the CANS-NY so that it may be used as a tool for functional assessment of children to determine level of care and level of need for services. Information regarding proposed modifications, procedures for administering the CANS-NY and any required training will be made available as this work progresses.
7. How long can an individual continue to benefit from Health Homes services? What is the expected length of stay within a Health Home?
There is no specified duration for the care management services provided by a Health Home and individuals may continue to be served by Health Homes provided they continue to meet eligibility criteria. If it is determined that a member no longer qualifies for or requires the intensity of care management provided by the Health Home, the member can be transitioned to another level of care (for example, a Patient Centered Medical Home). A transition plan must be developed by the Health Home.
8. Why limit Health Home eligibility to children in foster care when children receiving Preventive Services have similar rates of co-occurring behavioral and medical disorders? Shouldn’t any child in the child welfare system receiving special medical services be eligible?
Health Home eligibility is not limited to children in foster care. The Health Home eligibility criteria cannot be population based, it must be condition based. Any child in the child welfare system could be served in a Health Home, provided they meet eligibility criteria.
Outreach, Engagement and Referrals
9. How will children getting placed through the court system get referred to Health Homes?
Health Homes seeking to serve children will need to develop relationships with the Child Welfare System and the Juvenile Justice system. For more information, see Part I of the Health Home Application to Serve Children.
10. Will the County Single Point of Access (SPOA) be the primary source for referrals of children for Health Home services? How will Health Homes work with SPOAs?
The SPOA will be an important source of referrals for children for Health Home services, but not the only source. As with adults, referrals for Health Home services can be made from a variety of sources including medical and behavioral health providers, hospitals, local social service districts, and community based organizations. Existing Health Homes have developed unique relationships with their local SPOAs; newly designated Health Homes would also be expected to develop these local relationships.
Eligibility and Enrollment
11. What are the Health Home eligibility criteria for children?
A child must be enrolled in Medicaid and have at least two chronic conditions or one single qualifying condition of HIV/AIDS or Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). Pending approval from CMS, trauma with risk for another chronic condition will be added to the Health Home eligibility criteria (risk is defined as one or more functional impairments or an out of home placement). More information can be found at the link below:
12. Will the Department need to wait for CMS approval of the trauma eligibility criteria prior to releasing the final Health Home Application to Serve Children?
CMS has provided guidance supporting the provision of integrated care management such as that provided by Health Homes to children who have experienced trauma. The definition included in the draft Health Home Application to Serve Children was modeled on this CMS guidance therefore we are confident that this addition to our eligibility criteria will be accepted, but we will finalize this based on conversations with CMS.
13. Once children are enrolled in Health Homes, can providers continue to serve children who are not Medicaid eligible and still under their parent’s private insurance? Currently children with private insurance are served by CMCM, how will those children be served under Health Homes?
In order for a child to receive Health Home services they must meet the eligibility criteria, which includes being a Medicaid recipient. Options for deeming children to provide them with Medicaid eligibility are being explored.
14. Will children who were enrolled in in the former TCM’s be assigned a legacy rate?
The Department and its State Agency partners are discussing the transition of former TCM programs and legacy rates. More information will be made available on our Health Home website as policies are developed.
15. What will happen to the 1915(c) Home and Community Based Services (HCBS) waivers in the Health Home model of care management?
The care coordination services under the Children’s 1915(c) HCBS Waiver programs i.e., the OCFS Bridges to Health Programs (for SED, MFC, and DD), OMH HCBS Waiver, and DOH CAH I and II, will begin to convert to Health Home on January 1, 2016. The State will be working to develop a detailed plan to transition and phase-in children enrolled in these waivers to Health Homes and managed care.
Health Home Design
16. Is High Fidelity Wrap the same as a HARP for adults?
While both the High Fidelity Wraparound (HFW) and the Health and Recovery Plans (HARPs) have similar philosophy in that they are intended to provide focused individualized services to a distinct population, the HARP is a managed care product for adults meeting specific utilization and functional criteria to receive intensive behavioral health (mental health and substance use disorder) services, whereas HFW is an evidenced-based approach to providing care management for children. The State is considering targeting children with complex behavioral health care needs that are involved in multiple child-serving systems for HFW, but is seeking input from providers and prospective applicants on the development of detailed criteria for HFW in the children’s Health Home model. For more information see Part I of Health Home Application to Serve Children.
17. How will children utilizing Article 31 clinics, co-located in schools be treated through Health Homes?
Medicaid eligible children participating in general education or special education, who meet the eligibility requirements of the Health Home program, and their families, will continue to receive services through Article 31 clinics co-located in schools, but will benefit from the comprehensive care management services available through the Health Home program. For more information, see Part I of the Health Home Application to Serve Children.
18. Will current children’s OMH TCM care management providers who, at this time serve children from 5-18 now be expanding age from birth to 18 with the inclusion of children receiving Early Intervention services?
Under the Health Home care management model, OMH TCM providers would have the option to serve children regardless of age once the provider has converted to Health Home; the decision to do so would be based on the expertise and capacity of the individual providers.
19. Are there any estimates for the required caseload ratios for serving children, besides the proposed ratio 1:10 for High Fidelity Wrap?
The State is seeking input from Stakeholders on whether there should be more prescriptive requirements for children’s Health Home, including staff qualifications and training, background checks, and required numbers of contacts. Stakeholders can also provide their thoughts on clinically appropriate caseload sizes for consideration.
20. Will there be a coordination of the various pediatric assessment tools being used so that there is some efficiency in the assessment process?
Currently, the CANS-NY is under consideration as the single functional assessment tool for children, to be used to determine level of need and level of care for services. The CANS-NY is not intended to replace pediatric diagnostic or assessment tools used in localities.
21. Will current Children’s providers be guaranteed to get the children referred to the Health Homes they are a part of or can the Health Home refer the child to an adult serving program leaving programs to vie for the population they specialize in and less expertise in working with the child population?
Health Homes will be designated to serve children based on their network capacity and their commitment and ability to tailor their model to meet the needs of children. Health Homes will be monitored and those that do not refer children to providers with the appropriate expertise could potentially lose their designation.
22. Must a Health Home address the needs of all children in their region that meet eligibility criteria? Can a Health Home reach out to network providers outside of their region?
A Health Home may be designated to serve children from a broader region and utilize providers outside their network or region as necessary to meet the needs of their members.
Billing and Payment
23. Who will be doing the billing on behalf of downstream providers? Will legacy TCM providers serving children be able to directly bill for services during the years that their legacy rates are guaranteed? Or will the Health Home be doing all billing on behalf of their downstream providers?
The decision as to whether downstream partners will bill directly for the legacy slots is still under consideration.
24. Will all Office of Children and Family Services (OCFS) funding be converted to Health Home?
OCFS Child Welfare, including Preventive Service funds, will not be converted to Health Homes. The OCFS Bridges to Health, Health Care Integration (care management) funding will be converted to Health Home in 2016.
25. How will consent be handled for children in Health Homes? Will the state provide guidance on how often minor consents need to be revisited/updated as children grow older?
The State will be working to develop a Health Home Patient Information Sharing Consent form for children. The State’s goal, to the extent possible, is to develop a uniform consent form. The form will recognize the rights of minors to consent to certain types of health care without the permission of their parent/guardian and to whether parents/guardians or others can access their health information. These discussions are happening with the NYS DOH legal advisors presently and the need to revisit and update consent as children grow older and their circumstances change will be considered.