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2 Today s Presentation Presenters: Clyde Comstock, President, CHHUNY Board of Directors Ray Schimmer, Executive Director, CHHUNY Chris Bell, Director of Children s Health Home Implementation, HHUNY

3 Agenda Review what we know about the roll out of the Children s Health Home later this year Provide concise steps for your agency to take today Discuss how your agency can project enrollment as you ready your agency to begin providing Health Home Care Management in October Contracting Process

4 Agenda Review what we know about the roll out of the Children s Health Home later this year Provide concise steps for your agency to take today Discuss how your agency can project enrollment as you ready your agency to begin providing Health Home Care Management in October Contracting Process

5 Review of what we know To ensure enough time to cover everything and allow for a dialogue, we will progress through these slides fairly quickly, stopping to highlight differences from what we ve previously communicated As a reminder, the session is recorded; the recording and the slides will be made available on the website for future reference.

6 Current State of CHHUNY Network CHHUNY has grown to include 160 Care Management Agencies! 140 agencies have provided us with a Single Point of Contact, which is used by the Department of Health to establish accounts for the Health Commerce System (HCS) and Medicaid Analytics & Performance Portal (MAPP) It is not too late to join the network if your agency would like to serve children by providing Health Home Care Management Services BUT we anticipate closing CMA enrollment on July 31 st so that we can conclude contracting and training in time for go-live

7 Children s Transition Timelines Children will begin to enroll in Health Homes designated to serve children on October 1, OMH TCM providers and legacy clients will transition on October 1 st as well. The mechanics will be outlined by DOH, but OMH TCM children will be auto-enrolled in Health Homes on October 1 st!

8 Health Home Organizational Chart Department of Health Designates Health Homes through Application Process Sets standards and monitors performance Managed Care Organizations Refers eligible children to HH Monitors quality outcomes and reviews with HH Health Home Administrative Services Network Management HIT Support/Data Exchange Note: For children in Foster Care, the VFCA is the Downstream Care Management Agency Downstream Care Management Agency Delivers care management Downstream Care Management Agency Delivers care management Downstream Care Management Agency (VFCA) Delivers care management

9 Voluntary Foster Care Agencies and Local Departments of Social Services Have Key Role in Health Home Model for Children VFCA will serve as a Care Management Agency, providing Health Home Care Management services to children enrolled in the Health Home. (The VFCA will primarily provide care management for children in Foster care, but may also provide care management to children not enrolled in foster care or that transition out of foster care) LDSS and the serving VFCA will decide together if they think individual FC children are eligible for Health Home Care Management Services LDSS provides consent to refer and enroll Foster care children in Health Home Care Management LDSS assigns child to VFCA for purpose of providing Health Home care management and enters referral in MAPP LDSS is the only entity (for children in foster care) that can enter referrals into MAPP (outside of NYC) The serving VFCA will then choose (in MAPP) the Health Home with which it wants to work

10 Current Health Home Eligibility Criteria Active Medicaid (including FFS or Managed Care), AND Two or more chronic conditions, OR One single qualifying condition of HIV/AIDS, or Serious Mental Illness (SMI) (Adults), or Serious Emotional Disturbance (SED) (Children), or Complex Trauma (Children)

11 Current Health Home Eligibility Criteria Chronic Conditions Include: Alcohol and Substance Abuse Mental Health Condition Cardiovascular Disease (e.g., Hypertension) Metabolic Disease (e.g., Diabetes) Respiratory Disease (e.g., Asthma) Obesity BMI >25 (BMI at or above 25 for adults, and at or above 85 th percentile for children) Other chronic conditions (see DOH website for list of chronic conditions) ealth_homes/docs/ _eligibility_criteria_hh_services.pdf

12 Current Health Home Eligibility Criteria SED Eligibility Criteria for Health Homes (Qualifying DSM Categories): Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma-and Stressor-Related Disorders Dissociative Disorders Somatic Symptom and Related Disorders Feeding and Eating Disorders Disruptive, Impulse-Control, and Conduct Disorders Personality Disorders Paraphilic Disorders ADHD (detail on next slide) *Any diagnosis in these categories can be used when evaluating a child for SED. However, any diagnosis that is secondary to another medical condition is excluded

13 Current Health Home Eligibility Criteria ADHD has been proposed to be added to the SED Eligibility Criteria with the following criteria: Currently taking psychotropic medication, AND Utilized any of the following services in the past three years: Psychiatric Inpatient Residential Treatment Facility Day treatment Community residence Mental Health HCBS Waiver OMH Targeted Case Management

14 Current Health Home Eligibility Criteria Information from slide 30 of DOH Webinar held on April 7 th, 2016

15 Current Health Home Eligibility Criteria Information from slide 33 of DOH Webinar held on April 7 th, 2016

16 Current Health Home Eligibility Criteria Documenting Trauma In documenting complex trauma eligibility, care managers may document determinations made by practitioners (defined as appropriate diagnoses made by Medicaid qualified providers that are licensed practitioners acting within their scope of practice), or professionals that are trained in trauma (e.g., professionals that have completed OCFS Common Core Curriculum (which teaches individuals to identify abuse/maltreatment, intervene to stop it, prevent it, and support children and family members to begin healing from the effects of it. Practitioners or professionals may use any of the tools identified by the National Child Traumatic Stress Network to support their determination. Tools can be found here: ***NOTE: This slide is no longer accurate following the release of the updated process flow and tools available on the DOH website (URL on slide 18). Only those providers who are on the next slide are able to complete the CT Exposure Assessment form and document Complex Trauma for the purposes of determining Health Home eligibility***

17 Current Health Home Eligibility Criteria Licensed Providers who can document complex trauma Licensed Masters Social Worker, LMSW Licensed Clinical Social Worker, LCSW Psychologist Psychiatrist Licensed Psychiatric Nurse Practitioner, LNPP, Licensed Marriage and Family Therapist, LMFT, Licensed Mental Health Counselor, LMHC Pediatrician/Family Medicine Physician or Internist with specialization in Behavioral Health

18 medicaid_health_homes/health_homes_and_children.htm

19 Appropriateness Criteria for Health Home Eligibility Individuals meeting the Health Home eligibility criteria must be appropriate for Health Home care management. Assessing whether an individual is appropriate for Health Homes includes determining if the person is: At risk for an adverse event (e.g., death, disability, inpatient or nursing home admission, mandated preventive services, or out of home placement) Has inadequate social/family/housing support, or serious disruptions in family relationships; Has inadequate connectivity with healthcare system; Does not adhere to treatments or has difficulty managing medications; Has recently been released from incarceration, placement, detention, or psychiatric hospitalization; Has deficits in activities of daily living, learning or cognition issues, or Is concurrently eligible or enrolled, along with either their child or caregiver, in a Health Home.

20 Consent Under Current Law and Regulations, Parental Consent, with only Limited Exceptions, is Required for Children to be Enrolled in Health Home The PHL defines Health Home care management as a health service, and as such requires the consent of a parent, guardian or legally authorized representative to enroll minors in a Health Home and authorize information sharing among the minors provider Exception: A minor who is married, pregnant, or a parent can consent to enrollment into a Health Home and provide authorization to have their health information shared (the current consent form DOH 5055 would be used in these circumstances)

21 Referral Mechanisms There are basically 4 ways a Care Management Agency will receive referrals: As a TCM provider whose TCM kids will roll over automatically into HH As a CMA that is assigned referrals in MAPP of children referred by MCOs, LDSS, or SPOA/LGUs As a CMA that has referred its eligible clients via MAPP As a CMA with additional capacity to serve children referred to CHHUNY from parties outside this system (e.g. Pediatricians)

22 Referral Processes Draft Direct Referral (i.e. Self Referral) and Assignment Process Referrals by CMAs for Children NOT in Foster Care CMA obtains consent to refer, and explains HH FAQs CMA enters referral into MAPP portal HHUNY accepts the referral and assigns to CMA, in MAPP CMA accepts assignments in MAPP (daily) HHUNY assignment into Netsmart, creating a client chart (daily) CMA assigns a Care Manager to the client, in Netsmart Care Manager works with the child/youth family to educate on Health Home care management and obtain consent to enroll

23 Referral Processes Draft Indirect Referral (i.e. Community Referral) and Assignment Process Referrals by LGU, SPOA, LDSS, MCP for Children NOT in Foster Children Preliminary determination that the child is HH eligible LGU/SPOA/LDSS/ MCP provides Parent/Legal Guardian FAQ sheet and explains HH Agency obtains consent to refer, enters referral into MAPP Agency recommends Health Home assignment FFS: MAPP will run an algorithm to assign to HH Managed Care: MCP will select HH for referral HHUNY accepts the assignment in MAPP, assigns to CMA, following process from above

24 Referral Processes Draft Indirect Referral by LDSS to VFCA for Children in Foster Care LDSS determines that the child is eligible for HH care management LDSS enters consent to refer, referral information, and VFCA assignment into MAPP VFCA accepts assignment in MAPP, and selects the HH for this assignment Assignment to the Health Home will appear in MAPP HHUNY accepts the assignment in MAPP, creates client record in Netsmart VFCA assigns Care Manager in Netsmart who begins outreach

25 Consent Forms DOH Finalized the Consent Forms to be used in the Children s program: Health Home Consent Frequently Asked Questions For Use with Children and Adolescents Under 18 Years of Age Health Home Consent Enrollment For Use with Children and Adolescents Under 18 Years of Age (DOH 5200) Health Home Consent Information Sharing For Use with Children and Adolescents Under 18 Years of Age (DOH 5201) Health Home Withdrawal of Health Home Enrollment and Information Sharing Consent Form For Use with Children and Adolescents Under 18 Years of Age (DOH 5202) Health Home Consent Information Sharing Relesease of Educational Records (DOH 5203) Health Home Consent Withdrawal of Relsease of Educational Records (DOH 5204)

26 CANS-NY and Health Homes (CANS-NY Child and Adolescent Needs and Strengths Assessment-NY) The CANS-NY assessment (as modified for New York) will be used: To assist in the development of the person centered care plan Determine acuity for Health Home rate tiers Provide information that may help determine if children meet the Health Home eligibility functional criteria for Serious Emotional Disturbance (SED) and Trauma CANS-NY by itself will not determine Health Home eligibility CANS will also be used to determine the eligibility for Home and Community Based Services (HCBS) that will be made available with the behavioral health and health benefit transition to Managed Care in 2017

27 Medicaid Analytics Performance Portal Anticipated MAPP Functionality at Go Live Referral entry of potentially eligible children Consent management (e.g. to refer, enroll, share information) Assigning eligible individuals to Health Home Enrolling an individual into a Health Home once outreach is complete Transfer of individuals between Health Home Billing Support (Members MCO, HH, and CMA and Diagnosis information) Ability to check on member s connection to Health Home Member batch lookup and export Dashboard to assist care managers, Plans and Health Homes to manage performance, identify and evaluate best practices

28 Disenrollment Health Homes will also be responsible for transitioning children who turn 21 into adult Health Home services. Children that no longer meet the criteria for enrollment should be discharged from the Health Home. The Health Home will be responsible for ensuring that these children are transitioned into appropriate levels of care.

29 Reimbursement Rates The table below outlines the reimbursement rates to the Lead Health Home by each acuity level. Each Health Home deducts a fee for administration and operation of the Health Home. Acuity or Activity Reimbursement (PMPM) High $750 Medium $450 Low $225 Outreach $135 CANS-NY $185 (1 per client)

30 DOH Required Training CANS-NY Training is currently available here: Supervisors must achieve a score of 80% or higher Care Managers must achieve a score of 70% or higher Mandated Reporter Training 2 hour training available at NO COST Consent HIPPA/CFR 42/sharing of information (future detailed webinar by DOH forthcoming) Trainings provided by State for Health Homes Serving Children

31 Staying Informed DOH has created an distribution list to share information. You can join the list via the link below:

32 Agenda Review what we know about the roll out of the Children s Health Home later this year Provide concise steps for your agency to take today Discuss how your agency can project enrollment as you ready your agency to begin providing Health Home Care Management in October Contracting Process

33 Your planning will help CHHUNY s Planning Agencies signed up as CMA with CHHUNY CMAs serving children in October

34 Readiness Planning Key Steps Ensure your agency has provided us a BAA, SPOC, MMIS Work with DOH to ensure HCS and MAPP access Attend DOH webinars and have staff view these trainings Execute contract with CHHUNY Estimate the reliable number of children your agency will be able to refer in October Think about staffing to provide HH Care Management services Understand the financial impact

35 Readiness Planning Agency Information We have posted several lists of Care Management Agencies to the CHHUNY website Please check to ensure your agency is included among the list of those who have provided all required information to CHHUNY to move forward with contracting If you find your agency on a list indicating we are missing information, see the instructions to complete the missing item

36 Readiness Planning You, the HCS and MAPP DOH communicated with your agencies Single Point of Contact on March 16 th with instructions to set up an HCS Organizational Account. Some agencies without an MMIS number were contacted via the SPOC on March 14 th with instructions to obtain an MMIS first Additional communication from DOH will be sent to the CMA in the near future The process takes time and so it is important to get started ASAP: DOH will send your SPOC the request for application form (noted above) You agency must send the appropriate forms back to designate an HCS Director and HCS Coordinators (2) DOH will then provide those persons with the official application to be completed and returned (which must be notarized)

37 Readiness Planning HCS and MAPP Your staff will log into HCS in order to access MAPP (i.e. MAPP is housed within HCS) The relationship between HCS and MAPP can be confusing. HCS Director HCS Coordinator MAPP Gatekeeper MAPP Workers The HCS Director is an executive at your agency, and designates the HCS Coordinators. The HCS Coordinator creates additional HCS accounts for your agency staff The MAPP Gatekeeper can create Worker accounts in MAPP The same person can be the HCS Coordinator and MAPP Gatekeeper The MAPP Worker is someone at your agency who will use MAPP to enter referrals and accept/reject assignments

38 Health Home Serving Children (HHSC) Training Schedule JUNE and JULY 2016 Schedule of Upcoming Trainings Health Homes Serving Children JUNE & JULY 2016 Information on the NYS Child Welfare System and Defining the Collaborative Roles for HH and CMAs Complex Trauma draft proposal review to obtain stakeholder feedback June 1 st June 8 th Information regarding OASAS Programs, Services and Addiction for HH and CMAs CANS-NY - In person training - Albany School of Public Health Auditorium Health Home Serving Children Billing Guidance CANS-NY - In person Training - NYC 90 Church St MAPP Referral Portal Care at Home (CAH) I & II June 15 th June 22 nd & 23 rd June 29 th July 12 th & 13 th July 13 th July 27 th **These slides were ed to the Health Home List Serve on 6/20/

39 Health Home Serving Children (HHSC) Training Schedule AUGUST 2016 Schedule of Upcoming Trainings Health Homes Serving Children AUGUST 2016 Child Welfare interface with Health Home Serving Children - Roles and Responsibilities August 10 th Health Home Serving Children Consent Process CANS-NY In person Training - Rochester Training - Hillside Family of Agencies Health Home Serving Children outreach, eligibility and appropriateness determination August 17 th August 18 th & 19 th August 24 th CANS-NY - In person training - NYC 90 Church St August 29 th & 30 th OMH TCM program transition August 31 st **These slides were ed to the Health Home List Serve on 6/20/

40 Health Home Serving Children (HHSC) Training Schedule SEPTEMBER 2016 Schedule of Upcoming Trainings Health Homes Serving Children SEPTEMBER 2016 Health Home Serving Children 101 for Early Intervention Providers September 6 th Early Intervention Services and System for HH and CMAs MAPP training - MAPP HH User, HH CMA, MAPP for LDSS, LGU, SPOA, DOH and State partner users Health Home Serving Children 101 for HIV and AIDS providers Information and education from the AIDS Institute for HH and CMAs UAS training environment and how to use the system UAS Using the UAS to conduct CANS assessments UAS Understanding the CANS assessment UAS CAPS and SCALES UAS CANS Assessment Outcomes September 7 th Three weeks prior to go live TBD September 20 th September 21 st Available once user has HCS account provisioned roles TBD TBD TBD TBD **These slides were ed to the Health Home List Serve on 6/20/

41 Readiness Planning Initial Client Volume How many referrals can your agency expect in October? Consider the number of children your agency is already serving. This includes the FC children your agency is already serving The number of children your agency will self refer in October is the most reliable estimation of the number of referrals your agency will receive in October. Children in OMH TCM slots will automatically convert to Health Home care management, so be sure to count those as well

42 Readiness Planning Initial Client Volume Source: DOH April 9 Webinar

43 Readiness Planning Staffing Once you have an estimate of the number of children your agency will self-refer, you can begin to think about the number of staff you will need to serve them. In order to begin providing Health Home Care Management, your Care Managers and Supervisors will be required to train on the IT platform, Netsmart, be certified in the CANS-NY assessment. To help you think about the number of care managers you may need the next slide shows suggested caseload sizes for staff

44 * Modified CANS NY determines tier HH PMPM rate Health Home Staff to Caseload Ratios Tier* Suggested Caseload Ratio Care Management Service Requirements Care Management Qualifications High 1:12 Mandate 2 HH services/month, 1 must be face-to-face with youth; Caseload must be most/all high-acuity Bachelor s of Science or Art w/2 yrs. relevant experience; OR Registered Nurse with w/2 yrs. relevant experience ; OR Masters w/1 yr. relevant experience CM working with EI have specialized qualifications Medium 1:20 Mandate 2 HH services/month, 1 must be face-to-face with youth Low 1:40 Must demonstrate 1 HH service/month to bill No mandated qualifications identified, but expectation is assigned care manager has experience and skills needed to serve client and deliver the six Health Home core services No qualifications identified, but expectation is assigned care manager has experience and skills needed to serve client and deliver the six Health Home core services

45 Readiness Planning Financial Impact It is important to recognize that you will hire staff before there is any revenue. This is true even if you hire after the launch of the program, due to the timing of monthly billing of claims and the time it takes to receive payment We have developed a financial modeling tool to help your agency understand the financial impact. This tool is now on the CHHUNY website and will be shared via after the webinar.

46 Agenda Review what we know about the roll out of the Children s Health Home later this year Provide concise steps for your agency to take today Discuss how your agency can project enrollment as you ready your agency to begin providing Health Home Care Management in October Contracting Process

47 Contracting Process Contracts will be ed to the CEO/Primary Contact of each Care Management Agency in early July. In order to receive a contract, the agency must have signed a Business Associate Agreement and provided CHHUNY with the Single Point of Contact (SPOC) You can confirm your agency s status online at

48 Contracting Process Behind the Scenes CHHUNY s legal team is conducting a final review The financial piece is being finalized We want to be sure that you receive as much of the payment from DOH and the Managed Care Plans as possible! DOH has identified roughly $7M start-up funds to be released to new Health Homes like CHHUNY and adult health homes that are significantly expanding their footprint. However, we don t know how much CHHUNY will receive

49 CHHUNY s Approach to Contracting CMA centric Ideally the CHHUNY administrative charge would be an all inclusive charge to the Care Management Agencies so that you don t have to pay any extra costs

50 The Financial Piece: Our Assumptions The administrative charge to CMAs will be kept as low as possible; the CHHUNY Board members are CMAs themselves CHHUNY will bear all financial risk beyond the administrative rate; that is, CHHUNY will not pass on annual financial losses should there be any to CMAs On the other hand, should annual financial surpluses accrue, the Board will consider reductions in the CMA administrative rate where feasible.

51 The Financial Piece: Estimating Revenue CHHUNY estimates the gross number of potential clients on a monthly and annual basis CHHUNY estimates variable revenue from clients at various stages in the enrollment/service process: outreach, preacuity determination service, and the full care management service CHHUNY estimates an amount for DOH startup assistance

52 The Financial Piece: Estimating Expenses CHHUNY estimates the number of CMAs to be trained, provided with software and connected to Netsmart and Millin Associates CHHUNY calculates assorted charges by HHUNY, Netsmart, and Millin Associates CHHUNY adds its own expenses for insurance, legal, and independent contractors

53 Next Steps: Onboarding Care Management Agencies Contracts with Care Management Agencies will be distributed in July Agencies that sign the contract will be invited to join the future onboarding sessions The next will be held Monday, August 29 th from 12pm 1:30pm There will be regional face to face onboarding meetings scheduled in the last 2 weeks of September for final onboarding just prior to go-live

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