Draft Medicaid Health Homes for Individuals with Chronic Conditions Targeted Case Management Billing-Year One
August 19, 2011
|I'm the Health Home Care Management Provider - WHO DO I BILL?|
|Targeted Case Management (TCM) Provider||Non-Targeted Case Management Provider|
|Existing TCM Slots||New Health Home (TCM) Slots1||Fee-For-Service (FFS) Health Home Patient||Managed Care Plan - Health Home Patients (Not a TCM Provider)|
|1. If Managed Care Patient, bill eMedNY.||1. If MC patient (with Managed Care Plan Approval), bill eMedNY.||FFS Patient and I directly contract with State for HH services, bill eMedNY.||Patient is enrolled in Managed Care Plan – and I contract directly with Managed Care plan to provide HH services (I am approved lead by State), bill Managed Care Plan.|
|2. If Fee-For-Service (FFS) Patient, bill eMedNY.||2.
a) If FFS patient and I directly contract with State for HH services, bill eMedNY.
b) If FFS patient and I am a subcontractor with another lead HH (retain approval to bill) bill eMedNY.
|2. FFS Patient and I subcontract with another lead HH, bill lead HH.||2. Patient is enrolled with Managed Care plan and I subcontract with a Plan contracted HH Lead Contractor, bill lead Contractor.|
- 1. Nothing prevents a TCM provider from negotiating supplemental payments from lead health home plans or providers.