Health Home Policy and Updates

This page has been organized by policy topic and includes both policy and procedures, as well as guidance documents issued by the Department. Please check back here frequently for updates.

*Note that the current policy manual remains effective until otherwise noted.

Policy Topics

Background Checks

  • Background Check Requirements for Health Homes and Care Managers #HH0010 - (Web) - (PDF) - Revised February 2021
  • Mandatory Background Check Requirements for HCBS Providers and Health Homes - (PDF) - Slides revised April 2019
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Billing

  • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (Web) - (PDF) - November 2023
  • Medicaid Managed Care Plan Billing and Payment Protocol for Health Home Services - (Web) - (PDF) - Effective: July 1, 2018, Revised: March 2019
  • Coverage Code Compatibility with the Health Home Program - (Web) - (PDF)
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  • Access to/Sharing of Personal Health Information (PHI) and the Use of Health Home Consents #HH0009 - (PDF) - Updated May 1, 2022
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Eligibility

  • Health Home Notices of Determination and Fair Hearing Policy #HH0004 - (Web) - (PDF) - Updated April 2022
  • Eligibility Requirements for Health Home Services and Continued Eligibility in the Health Home Program HH0016 - (Web) - (PDF) - February 2024
    • Guide to Edits for the Eligibility Requirements for Health Home Services and Continued Eligibility in the Health Home Program HH0016 - (PDF) - February 2024
  • Guidance for Use of the Continued Eligibility for Services (CES) Tool - (Web) - (PDF) - February 2024
    • Guide to Edits for Guidance for Use of the Continued Eligibility for Services (CES) Tool - (PDF) - February 2024
    • DOH - Health Home Continued Eligibility for Services (CES) Tool - (PDF) - Updated December 2023
    • DOH - Health Home Continued Eligibility for Services (CES) Review Tool - (XLSM) - Updated December 2023
    • Appropriateness Criteria Codes HHSA & HHSC - (Web) - (PDF) - Updated February 2024
    • DOH Health Home Program Office Hours Q&As - (Web) - (PDF) - September 6, 2023
    • NYS DOH Initial Appropriateness and Continued Eligibility for Services (CES) Tool training slides - (PDF) - Updated December 2023
    • Health Home Initial Appropriateness and Continued Eligibility for Services (CES) Tool: Frequently Asked Questions (FAQ) - (PDF) - December 2023
  • Assertive Community Treatment and Health Home Updated Instruction - (Web) - (PDF)
  • Definition of Serious Mental Illness for Health Home Eligibility - (Web) - (PDF)
  • Updated Guidance for FIDA and Health Home - (Web) - (PDF) - Effective January 1, 2018
    • Desk Aid for Identifying FIDA, PACE, and FIDA IDD Members - (PDF)
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General Health Home

  • Program Guidance - Health Home Care Management for People Living with HIV and Persons at Risk for HIV - (PDF) - revised August 2022
  • Comprehensive Assessment Policy #HH0002 - (PDF) - Updated May 1, 2022
  • Member Disenrollment From the Health Home Program Policy #HH0007 - (PDF) - Updated May 1, 2022
  • Transfer Process Between Health Homes and Waiver Programs for Care Management Services - (PDF) - Updated April 2022
  • MAPP HHTS Segment End Date Category & Reason Codes Crosswalk and Guidance Chart - (PDF) - April 2022
  • COVID-19 Guidance for Health Homes - (PDF) - March 2020
  • COVID-19 Guidance for Children's Waiver Services Providers - (PDF) - March 2020
  • Health Home Care Management Activities and Billing Protocols for Managing Newly Referred Individuals from Excluded Settings #HH0011 - (PDF)
    • 1915(c) Children's Waiver and 1115 Waiver Amendments Webpage - (Web)
  • Health Home Plan of Care Policy #HH0008 - (Web) - (PDF) - Updated May 1, 2022
  • Continuity of Care and Re-engagement for Enrolled Health Home Members #HH0006 - (PDF) - Updated March 4, 2019
  • DHDTC DAL 17-04 - Hospital Requirements for Making Referrals to Health Home - (PDF)
  • DHDTC DAL 17-04 - Hospital Requirements for Making Referrals to Health Home - Questions and Answers - (PDF) (posted May 2017)
  • Monitoring the Reporting of Complaints and Incidents - (PDF)
  • Recipient Restriction Program (RRP) - (PDF)
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HARP and Adult BH-HCBS

  • Adult Behavioral Health Home and Community Based Services (BH HCBS) Guidance for HARP and HIV SNP Members Enrolled in Health Home - (PDF) - January 2022
  • Billing Guidance for the Administration of the NYS Eligibility Assessment for Behavioral Health Home and Community Based Services (BH HCBS) and the NYS Community Mental Health Assessment (Webpage)
  • Community Mental Health Assessment Billing Procedures
    • Community Mental Health Assessment Billing Procedures - (PDF)
    • 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 - (PDF)
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Health Home Serving Children (HHSC)

  • HHSC Eligibility, Appropriateness, Prioritization and 6 Core Services - (PDF) - (PDF) - March 2022
  • Eligibility Process, Policy and Chronic Conditions - (Web) - (PDF) - March 2022
  • Complaint and Grievance Policy for Health Homes Serving Children #HH0013 (HHSC Only) - (PDF) - Effective April 1, 2021
  • Conflict Free Care Management Policy #HH0012 (HHSC Only) - (PDF) - Updated: May 2020
    • Policy Revision Overview - for CFCM policy #HH0012 - (PDF) - Updated: May 2020
  • Health Home Program Chronic Condition Update with Developmental Disabilities Conditions - (PDF)
  • UPDATE Guidance Regarding RE Code 23 OMH HCBS Waiver Stepping Down to Health Home - (PDF)
  • HHSC Additional Guidance Regarding Program Referrals and Enrollment - (PDF) - Effective March 29, 2017 updated June 1, 2017
  • Referring Children in Foster Care and linking them to a Non-Voluntary Foster Care Agency (non-VFCA) Health Home Care Management Agency (HH CMA) - (PDF)
  • Approved Reasons and Processes to Correct CANS-NY Errors within the UAS-NY - (PDF)
  • Guidance Regarding Health Home Governance Fees and Payment Structures - (PDF) - October, 2016
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Outreach

  • Elimination of Health Home Billing for Outreach - (PDF) - Effective: July 2020
    • Elimination of HH Outreach Billing: Impact on the MAPP HHTS - (PDF) - Effective July 1, 2020
  • Interim Guidance Addressing Outreach Modifications - (PDF) - October 2017
  • Health Home Outreach Reprogramming - (PDF) - October 2017
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Performance and Quality Management

  • Health Home Quality Management Program #HH0003 - (PDF)
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Reportable Incidents

  • Health Home Monitoring: Reportable Incidents Policies and Procedures #HH0005 - (PDF) - Revised November 2022
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Sharing Protected Health Information (PHI)

  • HARP/Sharing Protected Health Information for Outreach to support Enrollment of Individuals in Health Homes - (Web) - October 2015
  • Guidance for Sharing Protected Health Information for Outreach by Health Homes Frequently Asked Questions - (Web) - (PDF) - October 2015
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