On January 26, 2012, New York State Department of Health (DOH) published a preliminary rollout plan for Health Home implementation on their website. As we previously reported, the Public Health and Health Planning Council (PHHPC) of the DOH approved an emergency rule to lift the State’s moratorium on accepting applications for new CHHAs.
The Preliminary Rollout Plan divides the Health Home population into four “mutually exclusive” patient categories based on illness or disability, including: Developmental Disabilities, Long Term Care, Mental Health and/or Substance Abuse, and All Other Chronic Conditions. The DOH believes this model takes into account the unique needs of these four patient groups and the current service delivery structures, in order to specifically tailor Health Home care management.
The “Overall Rollout” plan, to date, is divided into three waves. The first wave of Health Home implementation will include “Mental Health/Substance Abuse” and “Other Chronic Conditions” patient groups. This wave will be done in three phases, by county of recipient residence. Phase I includes ten counties and implementation is scheduled for February 1, 2012; Phase II includes sixteen counties and implementation is tentatively scheduled for April 1, 2012; and Phase III includes thirty-six counties and implementation is tentatively scheduled for July 1, 2012. A list of counties, by phase, is available here.
Wave One Home Health Member Assignment Algorithm
The State will directly assign eligible Health Home members to approved Health Home networks. For members enrolled in Medicaid Managed Care, the State will assign through health plans. An algorithm was developed by the State as a means of distributing Health Home members to each of the State approved Health Homes based on the following four factors: (1) Higher Predictive Risk for Negative Event; (2) Lower or No Ambulatory Care Connectivity; (3) Provider Loyalty; and (4) Geographic Factors. The first and second factors will assign the highest risk and highest cost members with the lowest primary and ambulatory care connectivity in each health home area. The third and fourth factors will then be used as markers for initial Health Home assignment.
The second wave of implementation will include the “Long Term Care” population which will also potentially include two additional components: (1) building Health Homes from existing managed long term care plan and (2) building care management networks of nursing homes and non-institutional providers.
The third wave of implementation will include the fourth group, the “developmentally disabled” population. This population will convert to Health Homes from an already existing targeted care management program.
To date, no further details have been released about waves two and three.
This post was contributed by Nancy Sciocchetti.