Policy and Standards

The policies and standards for Health Homes Serving Adults (HHSA) and Health Homes Serving Children (HHSC) may change over time. Any new or updated policies and guidance documents will be listed below under NEW HEALTH HOMES POLICY UPDATES! Please check back frequently for any policy and/or guidance document updates.

For a full selection of Health Home policies and guidance documents, please use the Health Home Policy and Updates link further down on this page.

New Health Home Policy Updates!

Newly issued and updated policies and guidance documents will remain posted here for a period of six months.

  • Restriction Exception (R/E) Code Compatibility with the Health Home Program - (Web) - (PDF) - July 2024

The current Health Homes Provider Manual - Policy and Billing can be accessed at the following link. This manual will remain "in effect" until otherwise noted.

This section contains ALL Health Home policies and guidance documents.

The Health Home Standards and Requirements explains and clarifies the roles and responsibilities of Lead Health Homes, downstream Care Management providers, and Managed Care Organizations (MCOs) for the provision of Health Home services.

Click here for the Standards and Requirements for Health Homes, Care Management Providers and Managed Care Organizations - Updated May 2022 (PDF)

This document contains the following sections:

  1. State Plan Standards and Requirements for Health Homes
  2. Additional Health Home Standards and Requirements
  3. Additional Health Home Standards and Requirements for Assisted Outpatient Treatment (AOT) enrollees
  4. Additional Health Home Standards and Requirements Related to the Provision of Home and Community Based Services to HARP Enrollees and HARP-eligible HIV SNP Enrollees.
  5. Additional Health Home Standards and Requirements for Health Homes Serving Adult Home Class Members Pursuant to a Stipulated Order and Settlement
  6. Additional Health Home Standards and Requirements for Health Homes Serving Children
  7. Standards and Requirements for MCOs Related to the Provision of Health Home Care Management Services
Medicaid Health Homes State Plan Amendments: The Health Home Program´s State plan amendments are official documents that describe the nature and scope of a state´s Medicaid program that has been approved by the Federal Department of Health & Human Services (DHHS).
In order to assist Health Homes in achieving the goals of increased quality of care as well as reduction in the cost of treatment, the New York State Office of Health Insurance Programs, Medicaid, partnered with the New York State Office of Quality and Patient Safety (OQPS) in an effort to leverage HIT. HIT can provide the tools for providers to better coordinate care for Medicaid patients at highest risk for severe medical outcomes. Visit the Health Information Technology Standards page.

To access the following and other versions of Department of Health Medicaid Update newsletters, please visit the DOH Medicaid Update main page

Health Home Standards and Requirements for Health Homes, Care Management Agencies, and Managed Care Organizations: