2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-L - Health Homes.

§  365-l. Health homes. 1. Notwithstanding any law, rule or regulation
to  the  contrary,  the  commissioner  of  health  is   authorized,   in
consultation  with  the  commissioners  of  the office of mental health,
office of alcoholism and substance abuse services, and office for people
with developmental disabilities, to (a) establish,  in  accordance  with
applicable  federal  law and regulations, standards for the provision of
health home services to Medicaid enrollees with chronic conditions,  (b)
establish  payment  methodologies  for  health  home  services  based on
factors including but not limited to the complexity  of  the  conditions
providers  will  be  managing, the anticipated amount of patient contact
needed to manage such conditions,  and  the  health  care  cost  savings
realized  by  provision  of  health  home  services,  (c)  establish the
criteria under which a Medicaid enrollee will be designated as being  an
eligible  individual  with  chronic  conditions  for  purposes  of  this
program, (d) assign any Medicaid  enrollee  designated  as  an  eligible
individual  with  chronic  conditions  to  a  provider  of  health  home
services.
2. In addition to payments made for health home services  pursuant  to
subdivision  one  of this section, the commissioner is authorized to pay
additional amounts to  providers  of  health  home  services  that  meet
process  or  outcome  standards  specified  by  the  commissioner.  Such
additional amounts  may  be  paid  with  state  funds  only  if  federal
financial participation for such payments is unavailable.
2-a.  Up  to  fifteen  million dollars in state funding may be used to
fund health home infrastructure development. Such funds shall be used to
develop enhanced systems to support  Health  Home  operations  including
assignments,  workflow,  and  transmission of data. Funding will also be
disbursed pursuant to a formula established by the  commissioner  to  be
designated  health  homes.  Such  formula  may  consider prior access to
similar  funding  opportunities,  geographic  and  demographic  factors,
including   the   population   served,   and  prevalence  of  qualifying
conditions, connectivity to providers, and other criteria as established
by the commissioner.
2-b. The commissioner is authorized  to  make  lump  sum  payments  or
adjust  rates  of  payment  to  providers  up  to a gross amount of five
million dollars, to establish coordination between the health homes  and
the  criminal  justice  system and for the integration of information of
health homes with state and local correctional facilities, to the extent
permitted by law. Such rate adjustments may  be  made  to  health  homes
participating  in  a  criminal justice pilot program with the purpose of
enrolling incarcerated individuals with serious mental illness,  two  or
more   chronic  conditions,  including  substance  abuse  disorders,  or
HIV/AIDS, into such health home. Health homes receiving funds under this
subdivision shall be required to document and demonstrate the  effective
use of funds distributed herein.
2-c.  The  commissioner  is  authorized  to  make grants up to a gross
amount of one million dollars for certified application  counselors  and
assistors   to  facilitate  the  enrollment  of  persons  in  high  risk
populations, including but not limited to  persons  with  mental  health
and/or  substance abuse conditions that have been recently discharged or
are pending release from state and local correctional facilities.  Funds
allocated  for  certified  application counselors and assistors shall be
expended through a request for proposal process.
2-d. The commissioner shall establish reasonable  targets  for  health
home  participation  by  enrollees  of  special needs managed care plans
designated  pursuant  to  subdivision  four  of  section  three  hundred
sixty-five-m  of this title and by high-risk enrollees of other Medicaid
managed  care  plans  operating  pursuant  to  section   three   hundred

sixty-four-j  of  this  title, and shall encourage both the managed care
providers and the health homes to work collaboratively with  each  other
to  achieve  such  targets.  The commissioner may assess penalties under
this  subdivision  in  instances  of  failure  to meet the participation
targets established pursuant to this subdivision, where  the  department
has  determined  that such failure reflected the absence of a good faith
and reasonable effort to achieve the participation targets, except  that
managed  care  providers  shall  not  be  penalized for the failure of a
health home to work collaboratively  toward  meeting  the  participation
targets  and  a  health home shall not be penalized for the failure of a
managed  care  provider  to  work  collaboratively  toward  meeting  the
participation targets.
3.  Until  such  time  as  the  commissioner obtains necessary waivers
and/or approvals of the federal social security act, Medicaid  enrollees
assigned to providers of health home services will be allowed to opt out
of  such  services.  In  addition, upon enrollment, an enrollee shall be
offered an option of at least two providers of health home services,  to
the extent practicable.
4.  Payments  authorized  pursuant  to  this section will be made with
state funds only,  to  the  extent  that  such  funds  are  appropriated
therefore,  until  such  time  as federal financial participation in the
costs of such services is available.
5. The commissioner is authorized to submit amendments  to  the  state
plan  for  medical assistance and/or submit one or more applications for
waivers of the federal social security act, to obtain federal  financial
participation  in the costs of health home services provided pursuant to
this section, and as provided in subdivision three of this section.
6. Notwithstanding any limitations imposed by  section  three  hundred
sixty-four-l  of  this  title on entities participating in demonstration
projects established pursuant  to  such  section,  the  commissioner  is
authorized  to  allow  such entities which meet the requirements of this
section to provide health home services.
7. Notwithstanding any law, rule, or regulation to the  contrary,  the
commissioners  of the department of health, the office of mental health,
the office for people with developmental disabilities, and the office of
alcoholism and  substance  abuse  services  are  authorized  to  jointly
establish  a  single  set  of operating and reporting requirements and a
single set of construction and survey requirements for entities that:
(a) can demonstrate experience in the delivery of health,  and  mental
health  and/or  alcohol  and substance abuse services and/or services to
persons with developmental  disabilities,  and  the  capacity  to  offer
integrated  delivery  of  such services in each location approved by the
commissioner; and
(b) meet the standards established pursuant to subdivision one of this
section for providing and receiving payment for  health  home  services;
provided,  however,  that  an  entity  meeting the standards established
pursuant to subdivision one of this section shall not be required to  be
an integrated service provider pursuant to this subdivision.
In  establishing  a single set of operating and reporting requirements
and a single set of construction and survey  requirements  for  entities
described  in  this  subdivision, the commissioners of the department of
health, the  office  of  mental  health,  the  office  for  people  with
developmental  disabilities,  and the office of alcoholism and substance
abuse services are authorized to waive any  regulatory  requirements  as
are  necessary  to  avoid  duplication  of requirements and to allow the
integrated delivery of services in a rational and efficient manner.
8. (a) The commissioner of health is authorized to contract  with  one
or  more  entities to assist the state in implementing the provisions of

this section. Such entity or  entities  shall  be  the  same  entity  or
entities  chosen  to  assist  in  the  implementation  of the multipayor
patient centered medical home program pursuant  to  section  twenty-nine
hundred  fifty-nine-a  of the public health law. Responsibilities of the
contractor  shall  include   but   not   be   limited   to:   developing
recommendations  with  respect  to program policy, reimbursement, system
requirements, reporting requirements, evaluation protocols, and provider
and patient enrollment;  providing  technical  assistance  to  potential
medical  home  and health home providers; data collection; data sharing;
program evaluation, and preparation of reports.
(b) Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or  section
one hundred forty-two of the economic development law, or any other law,
the  commissioner  of  health  is authorized to enter into a contract or
contracts under paragraph (a) of this subdivision without a  competitive
bid or request for proposal process, provided, however, that:
(i)  The  department of health shall post on its website, for a period
of no less than thirty days:
(1) A description of the proposed services to be provided pursuant  to
the contract or contracts;
(2) The criteria for selection of a contractor or contractors;
(3)  The period of time during which a prospective contractor may seek
selection,  which  shall  be  no  less  than  thirty  days  after   such
information is first posted on the website; and
(4)  The  manner  by  which  a  prospective  contractor  may seek such
selection, which may include submission by electronic means;
(ii) All reasonable and responsive submissions that are received  from
prospective  contractors  in  timely  fashion  shall  be reviewed by the
commissioner of health; and
(iii) The commissioner of  health  shall  select  such  contractor  or
contractors that, in his or her discretion, are best suited to serve the
purposes of this section.
9.  The  contract  entered into by the commissioner of health prior to
January first, two thousand thirteen pursuant to  subdivision  eight  of
this  section  may  be  amended  or  modified  without  the  need  for a
competitive bid or request for proposal process, and without  regard  to
the   provisions   of  sections  one  hundred  twelve  and  one  hundred
sixty-three of the state finance law, section one hundred  forty-two  of
the  economic  development law, or any other provision of law, excepting
the responsible vendor requirements of the state finance law, including,
but not limited to, sections one hundred  sixty-three  and  one  hundred
thirty-nine-k  of  the  state  finance  law,  to  allow  the purchase of
additional personnel and services, subject to available funding, for the
limited purpose of assisting the department of health with  implementing
the  Balancing  Incentive  Program, the Fully Integrated Duals Advantage
Program,  the  Vital  Access  Provider  Program,  the  Medicaid   waiver
amendment  associated  with  the  public  hospital  transformation,  the
addition of behavioral health services as a managed care  plan  benefit,
the  delivery  system  reform  incentive  payment  plan,  activities  to
facilitate the transition of  vulnerable  populations  to  managed  care
and/or  any  workgroups required to be established by the chapter of the
laws  of  two  thousand  thirteen  that  added  this  subdivision.   The
department  is  authorized  to  extend such contract for a period of one
year, without a competitive bid or request for  proposal  process,  upon
determination  that  the existing contractor is qualified to continue to
provide such services; provided, however, that the department of  health
shall  submit  a  request  for applications for such contract during the
time period specified in this subdivision and may terminate the contract

identified herein prior to expiration of  the  extension  authorized  by
this subdivision.