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 |
Footnotes
- 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.
