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Medicaid State Plan Amendment

Health Home TCM Legacy Rates

**UPDATE NOVEMBER 20th, 2013**

Please be advised that the Department of Health has submitted a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) to extend the legacy for the former OMH and COBRA Targeted Case Management (TCM) Health Home rates until January 2015, which is coincident with the carve-in of the behavioral health care benefit into Managed Care.  It is anticipated that legacy providers will continue to bill directly as long as the legacy rates are in effect.

Please also note that the Department has been working with stakeholders to simplify and modify the current Health Home payment structure to better align the per member per month care management fees with the required level of service intensity. We anticipate that this improved rate structure could be implemented prior to January 1, 2015.

We are working closely with our State Health Home Implementation Partners (The AIDS Institute, OMH, and OASAS) as well as our Health Home Managed Care Organization Workgroup to assure the new rates cover clinically appropriate caseloads. To ensure as smooth as possible transition to Managed Care we further plan to mandate this new rate structure for a period of time beyond 2015. Legacy rates will remain in place while the SPA is under review by CMS.

Original Implementation Plan

The original implementation plan for the Health Home program included a provision that would allow the converting OMH and COBRA Targeted Case Management Programs (TCMs) to bill their legacy rates for one year after the effective date of the State Plan Amendment (SPA) for each phase, a blended rate for year two, and the full Health Home rate for year three.

A delay in CMS approval of the SPAs for each phase has meant that the process of actively enrolling and billing for Health Home clients has not occurred as planned. To ensure that TCM programs can sustain their operations while Health Homes are still in the implementation phase, the TCM legacy rates will be extended into the second year of conversion to Health Home services as indicated in the Table below.

Rate Code Rate Code Description Phase 1 Phase 2 Phase 3
1851 HEALTH HOME/OMH-TCM Effective January 1, 2012 until December 31, 2013 Effective April 1, 2012 until March 31, 2014 Effective July 1, 2012 until June 30 2014
1852 HEALTH HOME OUTREACH/OMH-TCM
1880 HEALTH HOME/AIDS/HIV CASE MANAGEMENT
1881 HEALTH HOME OUTREACH/AIDS/HIV CASE MANAGEMENT

Rates for the Chronic Illness Demonstration Program (CIDP) will not be extended and will be in effect for one year as follows:

Rate Code Rate Code Description All Phases
1885 HEALTH HOME/CIDP CASE MANAGEMENT April 1, 2012 –March 31, 2013

OASAS Managed Addiction Treatment Services (MATS) programs have not billed Medicaid previously and thus billing for MATS legacy rates cannot begin until SPAs are approved. To avoid disruptions in funding, Phase II MATS programs will continue to be reimbursed by OASAS through State Aid until Phase II SPA's are approved. To offset the enrollment difficulties caused by the delay in SPA approvals and ensure that MATS programs can sustain their operations while Health Homes are still in the implementation phase, the MATS legacy rates will be extended into a portion of the second year of conversion to Health Home services as indicated in the Table below.

Rate Code Rate Code Description Phase 1 Phase 2 Phase 3
1882 HEALTH HOME/MATS Effective August 1, 2012 until December 31, 2013 Effective date of SPA approval until March 31, 2014 Not Applicable
1883 HEALTH HOME OUTREACH/MATS