On June 30, 2017, the NYS Department of Health (DOH) and Office for People with Developmental Disabilities (OPWDD) (the “State”) released its draft Application for Health Homes who will serve individuals with intellectual and/or developmental disabilities (“I/DD”). These Health Homes will be called “People First Care Coordination Organization Health Homes” (CCO/HHs). CCO Health Homes are modeled after existing Health Homes and are the first phase in the transition to managed care serving the I/DD population. The State will provide start-up grants to successful Health Home applicants.
The draft Health Home Application provides organizations interested in becoming a CCO/HH with information about the program. (See “Part I” of the draft Application which is available on DOH’s website). Information is included about how the Health Home model must be tailored to meet the needs of individuals with I/DD, the anticipated schedule for CCO/HH designation, and state requirements and standards for serving I/DD in Health Homes. Preliminary “Per Member Per Month” (PMPM) rates range from $317 to $637 depending on the region of the state and acuity level of the enrollee. PMPM rates for the first month of enrollment range from $950 to $1,012.
CCO/HH applicants must demonstrate they are controlled by one or more non-profit organizations with a history of providing or coordinating developmental disability, health, and long term care services to individuals with I/DD, including MSC and/or long term supports and services (LTSS). Applicants can form partnerships and governance structures that leverage existing Health Home infrastructure to maximize the use of existing administrative and technology investments to assist with start-up efforts. Successful applicants must demonstrate that they have the ability to serve at least 10,000 enrollees although applicants with the ability to serve at least 5,000 enrollees will be considered if their financial plans are viable. The State anticipates designating CCO/HHs to serve defined, regional areas, as set forth in the application.
On or before August 4, 2017, organizations may submit comments to the draft Application and Letters of Interest. The Form for submitting comments to the draft Application (Attachment A) and the Letter of Interest submission form (Attachment B) are available on DOH’s website under “Draft Application Documents”.
Release of the final Application and start-up grant Application is currently scheduled for September 30, 2017, followed by a November 30, 2017 due date to submit Applications.
Our attorneys have considerable experience in forming Health Homes and providing legal counsel to organizations that serve individuals with intellectual and developmental disabilities. If your organization is interested in becoming a Care Coordination Organization Health Home or has questions about the process, please contact Susan A. Benz, Esq. at firstname.lastname@example.org or Melissa M. Zambri at email@example.com for more information. The authors wish to acknowledge the contribution of Bridget C. Steele, Esq. in assisting with this Alert.