2018 LCM-01 - Clarification: Health and Recovery Plan (HARP) Enrollee Renewal (Recertification) on WMS

To: Local District Commissioners

Subject: Clarification: Health and Recovery Plan (HARP) Enrollee Renewal (Recertification) on WMS

Date: February 6, 2018

Division: Office of Health Insurance Programs

Attachments: Attachment I - 16 OHIP/LCM-1 – Transitioning MAGI Consumers from WMS to NY State of Health

The purpose of this Local Commissioners Memorandum (LCM) is to inform local departments of social services (LDSS) of the renewal (recertification) requirements for HARP enrolled individuals.

Effective October 1, 2015, Medicaid Managed Care (MMC) enrollees 21 years of age and older, found by the State to meet certain diagnoses and service utilization criteria related to behavioral health, are provided the option to enroll in a HARP. A HARP is a voluntary insurance plan that manages physical health, mental health and substance use services in an integrated way for adults with significant behavioral health needs.

The New York State of Health (NYSoH), also known as the Health Exchange, is currently unable to support HARP enrollment. A project is in progress to add HARPs as a plan selection on NYSoH. Until such project is complete, HARP eligible Medicaid recipients currently enrolled, or requesting to enroll in a HARP, must have eligibility maintained at the LDSS.

HARP Enrollees and HARP Eligible MMC Enrollees are not included in the MAGI Transition to NYSoH. Under 16 OHIP/LCM-1 – Transitioning MAGI Consumers from WMS to NY State of Health(attached), LDSS staff should not refer any HARP enrollees, or HARP eligible enrollees, to NYSoH.

Identifying HARP Eligibility and Enrollment

A series of Restrictions/Exemption (R/E) codes have been developed to identify eligibility and enrollment in a HARP.

  • H1 HARP Enrolled w/out HCBS Eligibility
  • H2 HARP Enrolled w/Tier 1 HCBS Eligibility
  • H3 HARP Enrolled w/Tier 2 HCBS Eligibility
  • H4 SNP Enrolled HARP Eligible
  • H5 SNP Enrolled HARP Eligible w/Tier 1 HCBS Eligibility
  • H6 SNP Enrolled HARP Eligible w/Tier 2 HCBS Eligibility
  • H7 Opted-out of HARP
  • H8 State-identified for HARP Assessment
  • H9 HARP Eligible-Pending Enrollment into HARP

Any consumer with an R/E code of H1-H3 must remain on WMS.

  • NOTE: Special Needs Plans (SNP) are supported on NYSoH.

Recertifying HARP Coverage

The LDSS is responsible for sending renewal packets to HARP enrollees on WMS.

In cases where current HARP eligible enrollees fail to renew on time and their case closes for failing to renew, the LDSS staff must not refer them to NYSoH if they reapply. The LDSS must re-determine eligibility so that the individual may re-enroll in a HARP with the case remaining at the LDSS.

Treatment of HARP Eligible MMC Enrollees on NYSoH

When a HARP eligible enrollee, whose case resides at NYSoH, voluntarily elects to enroll (opt-in) in a HARP, their Medicaid case must be transferred to the LDSS with the assistance of the New York State Department of Health (NYS DOH) and New York Medicaid Choice (NYMC). The referral process is manual and files are sent to identified LDSS staff.

Per the email sent to those LDSS's having MMC enrollees who need their Medicaid case transferred to WMS, the enrollee's Medicaid coverage will terminate on NYSoH the month of referral. To prevent a lapse in coverage, upon referral, coverage will be issued in WMS for four (4) months (month of referral plus three prospective months) in Upstate districts. Coverage is authorized for five (5) months in New York City (month of referral plus four prospective months due to a system delay in mailing the recertification form accounting for the additional 30 days). The LDSS will continue enrollment in the health plan indicated on the referral. NYMC will see the managed care enrollment upon the case opening in WMS and will enroll the individual in a HARP. Districts are required to process the case opening in WMS immediately upon receipt of the HARP referral.

Local districts should be aware that HARPs and Health Homes are also assisting HARP enrollees with their renewal notifications. Plans are conducting outreach to enrollees who may be losing Medicaid eligibility and plan enrollment due to failure to renew.

Any questions should be directed to your LDSS Medicaid liaison at (518) 474-8887 for Upstate counties and in New York City (NYC) (212) 417-4500.

Jason A. Helgerson
Medicaid Director