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Stage 2 Grant Announcement

Health Home Implementation Webinar

Medicaid Redesign Team Supportive Housing Health Home Pilot Project

Medicaid State Plan Amendment

Draft Managed Care Enrollee in Need of HH – Plan Roles and Responsibilities

Chart I

September 29, 2011

Plan is Lead Applicant Health Home Plan is Not a Lead Applicant Health Home
(Plan contracting all health home services)
  • Plan is responsible for providing HH services directly or by subcontract to State approved HH providers.
  • Plan is responsible for assuring access to HH services by including State designated HHs in their network.
  • Plan assigns enrollee to Health Home utilizing state loyalty and attribution data.
  • Plan assigns enrollee to Health Home utilizing state loyalty and attribution data.
  • Plan will manage all in plan services closely to meet HH objectives.
  • Plan will manage all in plan services and work closely with HH to meet HH objectives. HH must use the enrollee's health plan's network for plan benefit services or work with the health plan to expand the plan network as needed to meet member needs.
  • Plan will bill eMedNY for HH services.
  • Plan will bill eMedNY for HH services.
  • Plan keeps HH payment and/or distributes to network partners based on relative effort.
  • Plan distributes HH payment to contracted care management provider proportional to total HH care management.
  • Plan collects all hh data required both internally and from network partners and reports required care management and patient experience of care data directly to State.
  • Plan will share enrollee PHI with the HH that provides HH services to their enrollees. The HH will share enrollee information with the health plan.
  • HH will report required care management and patient experience of care data to the health plan and to the State as required by federal law (which states that data must be reported by the designated HH provider to the State as a condition of payment).
  • Plan is responsible for assuring patient HH outcomes.
  • Plan and HH share responsibility for assuring patient HH outcomes.
  • Plan keeps gain sharing dollars when operating Health Home entirely and distributes proportional to care management effort when contracting for HH services.
  • Plan distributes any gainsharing dollars to contracted care management provider proportional to total care management effort.