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What's New?

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

Year One Targeted Case Management Conversion Logic

Chart II

September 29, 2011

TCM Agency (A)
Targeted Case Management (TCM) Provider
Converts to Health Home as Lead or Partner
(Total HH Capacity X+Y)
Health Home (HH)Topic TCM Agency (B
Targeted Case Management (TCM) Provider
Does Not Convert to Health Home
(Total TCM Capacity Z)
Agency A:
Current Number of (TCM Slots: X)
Agency A:
(New HH Capacity: Y)
(under contract with Health Plan for MC enrollees)
Agency B:
Current Number of TCM Slots: Z
Yes Yes Health Home Standards No
TCM Rate Health Home Rate Payment Amount TCM Rate
Agency A1 Health Plan Slot Management1/Patient Assignment Agency B2
90% 90% Percentage of Federal Financial Participation 50%
Agency A will report to State and to health plan. Agency A will report to State (if lead applicant) and to health plan. Quality Reporting Measures and Evaluation N/A
(subject to existing TCM standards)
Agency A Responsibility shared by Agency A and the health plan. Outcome Accountability N/A
(subject to existing TCM standards)
Agency A bills eMedNY3,4 Agency A bills eMedNY with plan approval3,4 Claiming Agency B bills eMedNY

Footnotes

  • 1. With County input for OMH and with HH network input as appropriate for both COBRA and OMH.
  • 2. With County input for OMH.
  • 3. Fee-For-Service and Managed Care patients
  • 4. Agency A must track slots and bill the appropriate rate - in the case of patient health home assignment from a plan, Agency A must retain approval from the plan in order to support the fee for service claim.