Session 4 August 29, 2012

2 AGENDA Implementation Updates Status of Health Home/MCP Contracts Billing Review/News

3 DOH has answered CMS questions on Phase II and Phase III State Plan Amendments (SPAs) Enrollment/billing of new members in Phases II and III cannot proceed until SPAs are approved. However, members in converting TCM programs in Phase II counties should be collected by Health Homes and submitted to DOH through the Member Tracking System. At this time, Phase III members should not be submitted to DOH.

4 Phase III designation letters are on the way. In the meantime, newly designated Health Homes can: Ensure Health Commerce System (HCS) access Prepare updated network partner lists Enter into contract negotiations Health Home designations still pending for several counties (Albany, Otsego, Schoharie, Delaware and Chenango)

Two types of Agreements:  Plan specific template or “Approved Agreement”  Must include Key Provisions  Can be used to negotiate a mutually acceptable contract with Health Homes  These are Administrative Services Agreements, not a Provider Agreement – provider agreement language (e.g., credentialing requirements) and/or appendices should not be included  Standard Agreement  Basic contract that includes the Key Provisions  Must be used as is with no modifications, or if modified, must be submitted by Plan and becomes an “Approved Agreement” All agreements must be submitted for review and approval to DOH Bureau of Managed Care 5

Emblem HIP  Montefiore  Maimonides Medical Center  FEGS  Bronx Lebanon Medical Center  Institute for Family Living Fidelis  VNS Schenectady  Maimonides Medical Center  Bronx Lebanon Medical Center Healthfirst PHSP  Bronx Lebanon Hospital Center  Institute for Community Living  Maimonides Medical Center  FEGS Health & Human Services  Community Healthcare Network  Montefiore Medical Center Neighborhood Health Providers  Bronx Lebanon Medical Center  Institute for Community Living  Maimonides Medical Center  Community Healthcare Network  Montefiore (BAHN)  VNS New York Home Care Hudson Health Plan  Hudson Valley Care Coalition HealthPlus (Amerigroup)  North Shore Long Island Jewish MetroPlus  NYC Health and Hospitals Corp. UnitedHealthcare of New York  Community Healthcare Network  Bronx Lebanon Hospital Center  FEGs Health and Hospital Services System *As of August 28, 2012

7 TCM agencies bill eMEDNY directly for ALL members. This includes FFS and MC members, for legacy slots and Health Home slots. TCM agencies bill existing members for active enrollment, even if they have not yet signed the Health Home consent form.

8 Converting programs in Phase I can bill prospectively for members in converting programs using program-specific (OMH TCM, COBRA, MATS, CIDP) Health Home rates. Converting programs cannot bill the New Health Home rates (1386/1387) until they receive notice that the rates have been loaded onto their rate file New Health Home rates for converting programs will be based on a programs (TCM/COBRA/CIDP) average acuity rather than a provider specific acuity, due to low volume of submitted records. Effective 10/1/12, all rates will be calculated using member level acuity scores Joint OMH/DOH letter to OMH and COBRA TCM providers re: TCM regulations no longer apply once Health Home services are billed- will be ed/posted shortly

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