New York Health Homes

Program Location: 
Albany, NY
Payer Type: 

Reported Outcomes


New York implemented its 2703 Health Home initative in 3 phases, through 3 State Plan Amendments. The first amendment, SPA 11-56, extended Health Home coverage to low-income individuals in 10 counties effective January 1, 2012. The second amendment, SPA 12-10, extended the initiative to 13 additional counties on April 1, 2012. The third State Plan Amendment, SPA 12-11, extended coverage to the remaining counities in New York on July 1, 2012 and completed the final phase of the Health Home initiative implementation.  

New York Health Homes extend coverage to individuals with two chronic diseases, one chronic condition and the risk of developing another, or serious mental illness. New York Health Home services include: 

  • comprehensive care management,
  • health promotion; transitional care including appropriate follow-up from inpatient to other settings,
  • patient and family support,
  • referral to community and social support services,
  • use of health information technology to link services.

Related News & Resources

Payment Model: 

A per member per month care management fee that is adjusted based on region and case mix (from 3M™ Clinical Risk Groups (CRG) method) and this fee will eventually be adjusted by patient functional status. Fees range from $75-$390. Health homes are paid the full PMPM rate for patients in the “active care management group” (those who are fully enrolled and have been assigned a care manager who have received at least one core health home service during the quarter), or 80% of the PMPM rate for up to six months for eligible patients in the “case finding group” (patients identified as eligible and attributed to a health home but not yet enrolled or assigned a care manager).

Fewer ED / Hospital Visits: 
  • 23% decrease in hospital admissions and emergency room visits
Improved Access: 
  • 14% increase in primary care visits
Last updated January 2019
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