Health Home TCM Legacy Rates Extended
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 |
