New York State DOH Extends Health Home Application Deadline to October 3, 2011

The New York State Department of Health (“DOH”) recently announced that it has extended from September 1 to October 3, 2011 the filing deadline for submission of applications by interested organizations seeking to participate in the new Health Home program being established by Medicaid.  Under the health home program, DOH will provide reimbursement to eligible entities certified as “health homes” for care management and other related services to Medicaid beneficiaries suffering from multiple qualifying chronic conditions or a qualifying behavior health condition who are enrolled with the health home. 

The health home program is being established by DOH pursuant to NYS Social Services Law 365-L.  This law was enacted by the New York State Legislature earlier this year in response to recommendations from Governor Cuomo’s Medicaid Redesign Team calling for New York State to develop and implement a health home program as a way to achieve reductions in Medicaid’s expenditures on beneficiaries with multiple chronic illnesses, who have complex needs and account for a disproportionate share of Medicaid’s overall expenditures.  The opportunity to develop the health home program was made available under Section 2703 of the federal Patient Protection and Affordable Care Act, which authorized states to amend their State Medicaid Plans to establish a health home program for their state’s Medicaid populations with chronic illnesses.  The Affordable Care Act also incentivized states to establish such a program by providing a 90% federal match for the first two years of such programs, meaning that the federal government will fund $9 out of every $10 spent by DOH on the program.

Under the health home program, a Medicaid beneficiary who meets health home criteria will be assigned by Medicaid (on an opt-out basis) to a health home from which he or she would be entitled to receive health home services.  To be eligible, a Medicaid beneficiary must have either (i) two covered chronic conditions, (i) one covered chronic condition and the risk of developing another covered chronic condition, or (iii) a serious mental illness.  The covered chronic conditions are the following: asthma, diabetes, heart disease, HIV/ AIDS, hypertension, mental health condition, and substance abuse disorder.  Medicaid estimates that there are approximately 700,000 Medicaid beneficiaries statewide who would be eligible to be enrolled in a health home.  DOH will begin assigning the beneficiaries to health homes as soon as the program is commenced and will continue to do so until the entire eligible population is enrolled in health homes. 

Organizations eligible to become certified as a health home include (i) managed care plans, (ii) hospitals, (iii) medical, mental and chemical dependency treatment clinics, (iv) primary care practices, (v) patient-centered medical homes, and (vi) federally qualified health centers.  Health home services include comprehensive care management, care coordination and health promotion, comprehensive transitional care, patient and family support, referral to community and social support services, use of health information technology to link services, and quality measure reporting to DOH, in each case with respect to the full continuum of enrollees’ medical, behavioral health, and non-clinical healthcare related needs.  To carry out such services, a health home must use multidisciplinary teams led by a dedicated care manager who will assure that enrollees received needed medical, behavioral, and social services in accordance with a single plan of care.  In addition, the health home must develop a provider network comprised of (i) medical care providers (i.e., primary care, specialist, hospitals, etc.), (ii) behavioral health providers, and (iii) community based organizations and social service providers (i.e. housing, public assistance support), each of which would agree to collaborate with the health home in serving the Medicaid beneficiaries enrolled with the health home.  There are 37 core health home requirements as well as 11 functional requirements that a health home must meet across the foregoing domains.  These requirements can be found here.

Health homes will be reimbursed a per patient per month care management fee. This fee will be adjusted for each health home based on region, enrollment volume, case mix, and patient functional status.  The amount of the fee has not been made available by DOH yet, but DOH anticipates that it will do so by September 1, 2011. The care management fee will be paid in two increments: (i) During the first few months (e.g. 3 to 6 months) after a patient has been assigned to a health home, the health home will receive a reduced care management fee (i.e. a payment equal to a percentage of the care management fee, perhaps 80%), which is intended to cover the costs of outreach and engagement (known as the “case finding” fee); and (ii) once a patient has been assigned to a care manager and is enrolled in the health home program, the health home will receive the full care management fee, which is known as the “active care management” fee.  The active care management fee will be paid in two installments.  The first installment will be paid up front.  The second installment will be paid once the health home provider meets certain state quality metrics.  Additionally, after the first year of the program, health homes will be eligible to participate in a shared savings pool which will consist of a percentage (perhaps 15%) of the savings derived by the State from the program.

Organizations interested in becoming approved by DOH as a health home must submit to DOH a letter of intent by September 1, 2011.  The letter of intent should include: (i) The host or primary applicant; (ii) a preliminary list of the proposed Health Home network/partners; (iii) proposed service area; and (iv) initial capacity, which should specifically identify the number of Medicaid beneficiaries that the proposed Health Home is prepared to accept as assignments.  A full application must be submitted to DOH by October 3, 2011.  The health home program will commence on November 1, 2011.

Organizations interested in applying for the New York State Health Home Program can view the application here.

*This Bulletin was co-written with Rivkin Radler Summer Intern, Gregory Mitchell.