Draft COBRA HIV/AIDS and OMH TCM Guiding Principles for Health Home

August 22, 2011

  • 1) Statewide implementation.
  • 2) TCMs can be a lead Health Home (HH) and keep their existing TCM slots for 2 years. (conversion)
  • 3) TCMs can be a Health Home "network partner" and keep their existing TCM slots. (conversion)
  • 4) TCMs that convert to Health Homes will be held to Health Home standards for all their patients.
  • 5) TCMs that do not convert to Health Homes can remain TCMs, continue to use their TCM standards, and keep their existing TCM slots for up to 2 years post Health Home implementation. (non-conversion)
  • 6) Converting TCMs will manage their existing TCM slots and, as appropriate, will involve counties and other HH network members in slot management.
  • 7) Any new patients over the existing TCM slots will be Health Home enrolled and reimbursed using the new HH rate and payment.
  • 8) TCM converted Health Home slots will be paid at the existing TCM rate for the first year of implementation.
  • 9) TCM converted Health Home slots will be paid at a blended TCM/HH rate for the second year of implementation.
  • 10) TCMs will bill for all TCM converted and non-converted slots, for both managed care and Fee-For Service (FFS) patients through EmedNY with plan approval or lead health home approval as applicable
  • 11) TCM converted Health Homes with managed care enrollees must use the enrollee's health plan's network for plan benefit services or work with the health plan to expand the plan network as needed to meet the needs of HH enrollees.