I have a clarification on this issue from DOH. Although they mentioned the MC roll-out in this message, the extension of legacy rates is not necessarily tied to the MC Roll-out. So this extension date applies to the entire state, not just to NYC. Of course, anything can change.
Please be advised that the Department of Health will be submitting a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) to extend the legacy Health Home rates for the former OMH and COBRA Targeted Case Management (TCM) agencies until April 2015, which is coincident with the revised timeline for the initial carve-in of the behavioral health care benefit into Managed Care. It is anticipated that legacy providers will continue to bill directly as long as the legacy rates are in effect. Legacy rates and direct billing will remain in place while the SPA is under review by CMS.
Please also note that the Department continues to work with stakeholders to simplify and modify the current Health Home payment structure to better align the per member per month care management fees with the required level of service intensity. We anticipate that this improved rate structure will also be implemented effective April 2015.
Thank you,
The Health Home Team
NYS Department of Health Medicaid Program