NYS hospitals must adopt “Health Home” Referral Policies



February 24, 2017

Heath Care Alert

Author(s): Laurie T. Cohen

The New York State Department of Health recently issued a Dear Chief Executive Officer letter that requires hospitals to develop new Health Home referral policies and protocols and also attest to the adoption of such policies.

The New York State Department of Health (DOH) recently issued a Dear Chief Executive Officer letter (the CEO Letter) that requires hospitals to develop new Health Home referral policies and protocols and also attest to the adoption of such policies. The CEO Letter states that hospitals will have until May 15, 2017, to submit an “Attestation of Compliance with Federal and State Requirements for Hospitals to Refer Medicaid Recipients to Health Homes.” Such attestation may only be signed by the hospital’s Chief Executive Officer.

By May 15, 2017, every NYS hospital must:

  • Develop appropriate Health Home referral policies and procedures for qualifying Medicaid recipients
  • Educate hospital staff and implement these policies in a meaningful way
  • Submit the attestation form to DOH 

Such policies and procedures are expected to establish a process to identify and refer patients presenting in the hospital emergency department who may be eligible for enrollment in a Health Home. Eligible individuals must have Medicaid or be Medicaid eligible and have two or more qualifying chronic conditions or one single qualifying condition such as HIV/AIDS or serious mental illness. In carrying out these requirements, hospitals will need to provide eligible patients with information about the benefits of Health Home enrollment and will also need to obtain patient consent to make the referral to a Health Home. Hospitals may also be asked to submit their policies to DOH.

The CEO Letter also indicates that DOH will be reviewing and amending hospital discharge planning regulations (10 NYCRR § 405.9) in the coming months to further support Health Home referrals and enhance communication and collaboration between hospitals and Health Homes to coordinate care for Medicaid patients with chronic conditions. In the interim, DOH is encouraging hospitals to consider revising their discharge policies to notify Health Homes when a Health Home enrolled patient has been admitted to the hospital or is in the emergency department as well as to make referrals to a Health Home part of its discharge planning process.

The foregoing has been prepared for the general information of clients and friends of the firm. It is not meant to provide legal advice with respect to any specific matter and should not be acted upon without professional counsel. If you have any questions or require any further information regarding these or other related matters, please contact your regular Nixon Peabody LLP representative. This material may be considered advertising under certain rules of professional conduct.

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