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Health Home TCM Legacy Rates

**UPDATE OCTOBER 14th, 2014**

Please be advised that the Department of Health will be submitting a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) to extend the legacy Health Home rates for the former OMH and COBRA Targeted Case Management (TCM) agencies until April 2015, which is coincident with the revised timeline for the initial 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. Legacy rates and direct billing will remain in place while the SPA is under review by CMS, and the extension includes MATS legacy rates. The State Plan Amendment (#13-63) for the previous extension through January 2014 was approved on October 14, 2014 and rates have been approved as indicated in the table below.

Please also note that the Department continues to work 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 will also be implemented effective April 2015.

Rate Code Rate Code Description Phase 1 Phase 2 Phase 3
1851 HEALTH HOME/OMH-TCM Effective January 1, 2012 until March 31, 2015 Effective April 1, 2012 until March 31, 2015 Effective July 1, 2012 until March 31 201
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) were not extended and were 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 will extended as shown below.

Rate Code Rate Code Description Phase 1 Phase 2 Phase 3
1882 HEALTH HOME/MATS Effective August 1, 2012 until March 31, 2015 Effective date of SPA approval until March 31, 2015 Not Applicable