Health and Recovery Plan (HARP)/ Behavioral Health

Health and Recovery Plans (HARPs) will manage care for adults with significant behavioral health needs. They will facilitate the integration of physical health, mental health, and substance use services for individuals requiring specialized approaches, expertise and protocols which are not consistently found within most medical plans. In addition to the State Plan Medicaid services offered by Mainstream MCOs, qualified HARPs will offer access to an enhanced benefit package comprised of Home and Community Based Services (HCBS) designed to provide the individual with a specialized scope of support services not currently covered under the State Plan.

Individuals currently enrolled in HIV Special Needs Plans (HIV SNPs) meeting the serious mental illness (SMI) and substance use disorder (SUD) targeting criteria and risk factors for HARP will also be eligible to receive HCBS while enrolled in their HIV SNP. Access to HCBS for HIV SNP enrollees will require an assessment consistent with the HARP program.

All individuals enrolled in HARPs and those in HIV SNPs meeting the SMI and SUD targeting criteria and risk factors for HARP will be offered Health Home care management services. Eligibility for HCBS is determined through an assessment, called the New York State Eligibility Assessment, conducted by Health Home care managers. If an individual is determined eligible for HCBS, the Health Home care manager will complete the full New York State Community Mental Health Assessment. Health Homes will develop person–centered plan of care that integrates physical and behavioral health services and includes HCBS for individuals who are eligible

Adult Transition to Managed Care

The BH HCBS workflow shows the process (assessment, HCBS POC development, authorization) for how HARP eligible persons who are enrolled in a Health Home will receive BH HCBS.

The Adult Behavioral Health Home and Community Based Services (BH HCBS) Plan of Care template can be used for individuals enrolled in a HARP who are eligible for BH HCBS. This template was developed by the New York State Department of Health, the Office of Mental Health, the Office of Alcohol and Substance Abuse Services, and the Health Home/Managed Care Organization workgroup. This template incorporates all the Federal rules and regulations required for the Adult BH HCBS Plan of Care.

The BH HCBS Plan of Care Federal Rules and Regulations checklist is a list of the Federal rules and regulations for the Adult BH HCBS Plan of Care document. This checklist can be used as a guidance tool by any entity that does not choose to use the BH HCBS Plan of Care template. Any entity that creates their own Adult BH HCBS Plan of Care must ensure that all the Federal rules and regulations are incorporated into their document.

  • BH HCBS Plan of Care Federal Rules and Regulations checklist

The Person–centered Planning Process Federal Rules and Regulations checklist is a list of the Federal rules and regulations for the person–centered planning process. This check list can be used by care managers to ensure that the Federal rules and regulations were followed during the person–centered planning process.

  • BH HCBS Person–centered Planning Process Federal Rules and Regulations checklist

Updated Qualifications for HH+ SMI and NYS Eligibility Assessments for Adult BH HCBS:

The State remains committed to ensure that the high need behavioral health population shall be served by staff who meet the appropriate education and experience.
Effective 9/1/19, the following minimum staff qualifications apply to those serving HH+ SMI and administering NYS EAs:

Education

  1. A Master´s degree in one of the qualifying fields[1] and one (1) year of Experience; OR
  2. A Bachelor´s degree in one of the qualifying fields[1]and two (2) years of Experience; OR
  3. A Credentialed Alcoholism and Substance Abuse Counselor (CASAC) and two (2) years of Experience; OR
  4. A Bachelor´s degree or higher in ANY field with either: three (3) years of Experience, or two (2) years of experience as a Health Home care manager serving the SMI or SED population

Experience must consist of:

  1. Providing direct services to people with Serious Mental Illness, developmental disabilities, alcoholism or substance abuse, and/or children with SED; OR
  2. Linking individuals with Serious Mental Illness, children with SED, developmental disabilities, and/or alcoholism or substance abuse to a broad range of services essential to successful living in a community setting (e.g. medical, psychiatric, social, educational, legal, housing and financial services).

Supervision

Supervision from a:

  1. Licensed level healthcare professional[2] with prior experience in a behavioral health setting; OR
    OR
  2. Master´s level professional with two (2) years prior supervisory experience in a behavioral health setting.

AND

Training:

Completion of:
  1. Specific training on the array of services and supports available, person-centered care planning process, and assessment of individuals whose condition may trigger a need for HCBS and supports; and
  2. Mandated training on the New York State Eligibility Assessment instrument; and
  3. Additional training as required by the State.

Waiver of NYS Eligibility Assessor Qualifications for Adult BH HCBS

Effective September 1, 2019, care managers and supervisors may request a waiver of staff qualifications to administer NYS Eligibility Assessments for Adult BH HCBS. Refer to the Memo "Updated Staff Qualifications to Serve Health Home Plus (HH+) SMI and Assessor Qualifications for Administering the NYS Eligibility Assessment (NYS EA) for Adult BH HCBS" for full details.

Please submit all waiver requests online here: Waiver of NYS Eligibility Assessor qualifications for Adult BH HCBS and HH+ SMI

Important: Waiver approval alone does not authorize an agency to provide/bill for HH+ services or NYS Adult BH HCBS Eligibility Assessments; all other applicable requirements (e.g., HH+ Attestation, RCA contract) authorizing your agency for such still apply. For Adult BH HCBS Assessors, all currently mandated UAS-NY Assessor trainings are still required and cannot be waived. HH CMAs/RCAs who receive waiver approvals are responsible for notifying their Health Home(s) and/or MCO(s) accordingly.

______________________________

[1] Qualifying fields include education degrees featuring a major or concentration in: social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing or other human services field.
[2] Licensed level healthcare professional includes: Physicians, Psychiatrists, Physician´s Assistants, Nurse Practitioners, Psychiatric Nurse Practitioners, Registered Professional Nurses, Licensed Practical Nurses, Licensed Psychologists, Licensed Clinical Social Workers, Licensed Master Social Workers, Licensed Mental Health Counselors, Licensed Marriage and Family Therapists, Licensed Psychoanalysts, Licensed Creative Arts Therapists, and Licensed Occupational Therapists.

Training for the NYS CMH assessment was made available on May 15, 2015 for Health Homes in New York City. The training will be available to Health Homes in the rest of the state at a later time.

The two courses that are currently available in the UAS-NY Environment are:

  • 1000 UAS–NY Training Environment – This course provides an overview of the structure and navigation of the training environment
  • 1500 Understanding the Community Mental Health Assessment – This course is designated to prepare assessors to use the NYS Community Mental Health Assessment instrument.
  • Community Mental Health Assessment Requirements Letter – April 15, 2015

The UAS–NY Support for Users provides information that will assist with accessing the UAS–NY Training Environment. (PDF)

On September 24, 2015 and September 25, 2015, the State conducted a "HARP/HCBS Eligibility Assessment" webinar. The purpose of this webinar was to review the HARP/HCBS eligibility criteria, the HARP/HCBS Eligibility Assessment, and the associated outcomes. The presentation slides can be found below, and the recorded session will be posted to the UAS–NY Training Environment.

  • HARP/HCBS Eligibility Assessment Webinar Slides – September 25, 2015 (PDF)

The Managed Care Technical Assistance Center (MCTAC) will be providing training on the following topics:

  • Managed Care 101
  • Training on HCBS Services, to:
    • Provide foundational knowledge on each HCBS service, how they fit into plan of care, how they relate to other State services
    • Make a clear distinction between mental health vs. SUD
  • Workflow for Health Home care managers

These trainings are scheduled to begin in June 2015. More information is available at the following website: http://www.mctac.org/

  • Transition of Children in Foster Care in New York into Medicaid Managed Care (HTML) – November 3, 2015
  • Readiness Reviews of Contingently Designated Health Homes Serving Children (PDF, 2MB) – September 24, 2015
  • OMH TCM Serving Children Transition to Health Homes–Legacy Rates (HTML) – August 24, 2015
  • Overview for Care at Home I & II Providers (HTML)(PDF)(Recording) – August 13, 2015
  • Connecting to the Health Commerce System (HCS) (HTML)(PDF)(Recording) – July 9, 2015
  • Health Homes Designated to Serve Children – Next Steps (HTML)(PDF)(WMV, 62MB) – June 24, 2015
  • Transitioning Office of Mental Health Targeted Case Management Program Serving Children to Health Homes (HTML)(PDF)(Recording) – June 8, 2015
  • Data Exchange and Health Homes Serving Children: Data Exchange Application & Agreements for Health Homes Serving Children (HTML)(PDF)(WMV, 63MB) – May 27, 2015
    • NYS Department of Health Data Exchange Application & Agreement Document (PDF) – May 5, 2015
  • Health Home Serving Children: Consent Policy and Procedures (HTML)(PDF)(WMV, 90MB) – May 18, 2015
  • Referral and Health Home Assignment Process for Children– Example "Use Cases" (HTML)(PDF)(WMV, 87MB) – May 11, 2015
  • Tailoring Health Home Model to Serve Children: Design and Implementation Updates (HTML)(PDF)(WMV, 126MB) – April 29, 2015
  • Conference of Local Mental Hygiene Directors – Overview of Design of Health Home Model for Children (HTML)(PDF) – April 6, 2015
  • Commissioner´s Advisory Panel – Tailoring Health Homes to Serve Children (HTML)(PDF) – February 27, 2015
  • Overview of Final Health Home Application to Serve Children and Other Design Updates (HTML)(PDF) – November 5, 2014