Health Home Medicaid Provider Enrollment Requirements
Provider Enrollment Application to become a designated Health Home
Who is required to complete an application?
Organizations serving as lead Health Homes (e.g. that have received an approval letter from the New York State Department of Health identifying them as a "Designated Provider-lead Health Home") and any converting care management agencies such as OMH TCM, and COBRA providers that are billing directly for health home services, must be enrolled in Medicaid for category of service (COS) 0265, Health Home/ Care Management.
Management Addiction Treatment (MATS) providers must obtain an NPI, and complete a Medicaid Provider Enrollment application, if they have not done so already. For additional information concerning this process and/or forms, please call 1-518-485-2322 and a representative from the Office of Alcohol and Substance Abuse Services (OASAS) will assist you.
The Department's Provider Enrollment Unit has updated the provider enrollment application for Health Homes. The new application and instructions can be found on the emedny website Provider Enrollment.
At the right of this page select the Health Home link.
NOTE: Under the Provider Enrollment tab, see information regarding Application Fee.
Completed applications should be sent to Computer Science Corporation (CSC) at P.O Box 4603, Rensselaer, N.Y. 12144.
Questions regarding the provider enrollment application can be directed to CSC at 1-800-343-9000.
Converting care management organizations that appear on the Care Management Organization list below do not need to submit a Medicaid Provider Enrollment application. The DOH has developed an expedited process to complete these enrollments.
- Converting Case Management Provider Names (XLS, 86KB)
Health Home Name/Network and/or NPI# Change Requirements
Health Homes changing their name and/or NPI number from their originally submitted name and/or NPI number, and/or changes in their network, as identified on the Health Home Application or Designation Letter, must complete and sign a Notification Letter attesting to the applicable revisions. Health Homes will also need to amend the "name on file" with the existing DEAA (see paragraph below on DEAAs).
Completing and forwarding this Notification Letter to the Department of Health (DOH) will allow us to update your file, as well as provide any needed guidance regarding provider enrollment and any requirements that result from changes in your partner network (see paragraph below on Changes to your Health Home Partner Network), including Health Home Consent Forms.
The original Notification letter can be mailed to the Department at the following address:
Health Home Program
New York State Department of Health
Division of Program Development and Management
Corning Tower, OCP-720
Albany, New York 12237
The notification letter and any questions can be submitted electronically to the Health Home team by clicking on the left side tab "Email NYS Health Home Program". Questions can also be directed to the Health Home program at (518) 473-5569.
Additional Requirements for Lead Health Homes with Article Certifications
Lead Health Homes that hold certifications as clinics or hospital-based providers under Article(s) 28, 31 and/or 32 that change their name and/or apply for new NPI#s after receipt of their New York State Approved Health Home Letter, are requested to contact the following agency staff, respectively, for any additional guidance that may be needed regarding these changes.
Article 28 - Michele Cefferillo, Administrative Assistant, Bureau of Project Management, NYS Department of Health, (518) 402-0911
Article 31 - Michael Holley, Director, Bureau of Inspection and Certification, NYS Office of Mental Health, (518) 474-5570
Article 32 - Janet Paloski, Acting Director, Bureau of Certification and Systems Management, NYS Office of Alcoholism and Substance Abuse Services, (518) 485-2250
Changes to your Health Home Partner Networks
Changes to your partner network need to be reported by using the Notification Letter outlined above only if (a) the change will result in your inability to offer the full range of Health Home services as submitted in your initial application or (b) impact your ability to remain in compliance with Health Home standards and guidelines as outlined by the Centers for Medicare and Medicaid Services (CMS), in the State Medicaid Director Letter (SMDL) #10-024, Health Homes for Enrollees with Chronic Conditions or (c) the change was a result of a failure of a partner to meet expectations or was otherwise not mutual in nature.
Data Exchange Application Agreements (DEAAs)
Lead Health Homes
The lead Health Home must have an approved DEAA with DOH to allow the Department to share demographic data on Health Home members prior to obtaining their consent. Changes to the lead Health Home name or corporate structure may require an amendment to the approved DEAA. Lead Health Homes should contact the Privacy Coordinator as noted below for guidance on how to amend their DEAAs.
Adding new Health Home Partners
Lead Health Homes must have an approved DEAA with network partners (subcontractors) in order to share member demographics with them, prior to obtaining the Health Home member consent. A subcontractor packet was sent along with the initial Lead Health Home DEAA. This packet is intended to be used for all new partners (subcontractors) who receive member data prior to consent. The subcontractor packet may be obtained by contacting the Privacy Coordinator noted below.
Changes to Lead Health Homes
Changes to the Lead Health Home corporate name requires completion and submission of the following amendment to the DEEA: Application to amend the Lead DEAA
If any changes other than those listed above are made to the corporation or their subcontractors (partners), contact the Privacy Coordinator at the address below for instructions.
Caryl Shakshober, MS, Privacy Coordinator
New York State Department of Health
Office of Health Insurance Programs
Division of Program Development & Management
Corning Tower (OCP 720)
Albany, NY 12237
Health Home Patient Information Sharing Consent Form (DOH 5055)
Please note that Health Home Patient Information Sharing Consent form (DOH 5055) must remain up to date to reflect any changes in service providers. If Health Home service providers have changed, Health Homes/care managers must add or delete provider names on page 3 of the DOH 5055 form. The revisions must be initialed and dated by the Health Home/care manager and the Health Home member. More information on the consent form can be found here: Member Forms Page