Health Home Non-Medicaid Care Management

Background

Tompkins County is in the Southern Tier region of New York at the southern end of Cayuga Lake. The county is approximately 475 square miles and home to over 105,000 people. Tompkins County is home to Cornell University and Ithaca College. 

Funding for AOT and Non-Medicaid Care Management: Starting in 2012, the OMH Medicaid-funded adult Targeted Case Management (TCM) program transitioned to the NYS Department of Health (DOH) Health Home (HH) Care Management program (see DOH Policy and Standards), making this service eligible for Medicaid billing. Health Home enrollees receive a care manager who helps them develop a plan of care, connect with healthcare, mental health and substance use providers, social services, housing, and other community programs. Individuals without Medicaid are not eligible for the Health Home program. To ensure access to care management services for high-need individuals with Serious Mental Illness (SMI) who lack Medicaid, OMH provides State Aid funding to Specialty Mental Health Care Management Agencies (SMH CMAs) for non-Medicaid care management services under program code 2620.

Local Government Units (LGUs) directly contract with agencies using this funding to coordinate access to care management for high-need SMI populations, including those receiving Assisted Outpatient Treatment (AOT).

History of Assisted Outpatient Treatment: On August 9, 1999, the Governor signed Kendra's Law (Chapter 408 of the Laws of 1999), creating a legal framework for court-ordered Assisted Outpatient Treatment (AOT). This law aims to ensure that individuals with mental illness, especially those with a history of hospitalizations or violence, receive community-based services tailored to their needs. Kendra's Law was named in honor of Kendra Webdale, a young woman who died in January 1999 after being pushed in front of a New York City subway train by a man with a history of mental illness and hospitalizations who was not receiving treatment at that time. The law took effect in November 1999 and has been periodically reviewed by the legislature for renewal. Since its inception, the New York State Office of Mental Health (OMH) has evaluated the impact of Kendra's Law on individuals subject to court-ordered services. The New York State AOT program has consistently shown a 66% reduction in hospitalizations compared to periods before, during, and after AOT, along with a 73% decrease in incarceration and a 63% decrease in episodes of homelessness. Currently, just under 3,500 people are under active AOT orders across the state. Care Management is a required service in court-ordered AOT treatment plans. It is provided by non-Medicaid specialty mental health care management agencies contracted by the Local Government Unit (LGU) and funded through State Aid.

Oversight:

• The Local Government Unit (LGU) and/or Single Point of Access (SPOA) are responsible for the oversight of Specialty Mental Health Care Management services, including AOT Care Management services. 
• The Tompkins County LGU requires contracted providers to submit quarterly and annual program and financial performance data for review by the Tompkins County Community Services Board using a Results-Based Accountability (RBA) report, with measures to be co-developed during the contracting period
• OMH regional AOT Coordinators, along with OMH Central Office staff, are dedicated to monitoring and follow-up efforts, as well as trainings and guidance documents to support the LGU/SPOA.