Draft Medicaid Health Homes for Individuals with Chronic Conditions Year One Targeted Case Management Conversion Logic

September 9, 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) Agency B:
Current Number of TCM Slots: Z
Yes Yes Health Home Standards No
TCM Rate1 Health Home Rate Payment Amount TCM Rate
Agency A2 Health Home Slot Management Agency B3
90% 90% Percentage of Federal Financial Participation 50%
Health Home4 Health Home Quality Reporting Measures and Evaluation N/A
(subject to existing TCM standards)
Health Home4 Health Home Outcome Accountability N/A
(subject to existing TCM standards)
Agency A bills5 eMedNY Agency A bills eMedNY with appropriate HH/plan approvals Claiming Agency B bills eMedNY


  • 1. For COBRA TCM current unit based monthly billing will be changed to an equivalent PMPM.
  • 2. With County input for OMH and with HH network input as appropriate for both COBRA and OMH.
  • 3. With County input for OMH.
  • 4. Health plan's role in accountability is under discussion for patients in these slots.
  • 5. Fee-For-Service and Managed Care patients.