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What's New?

Health Homes Bi-Weekly Webinar

  • The normally scheduled bi-weekly webinar for (1/21) has been cancelled.

Health Home CMART

Health Homes Serving Children Application

Medicaid State Plan Amendment

Health Home Forms

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.

Footnotes

  • 1. Nothing prevents a TCM provider from negotiating supplemental payments from lead health home plans or providers.