Providers participating in the EmblemHealth Enhanced Care Prime Network (formerly, Medicaid Prime Network), currently see patients in the EmblemHealth Enhanced Care plan (formerly, Medicaid Managed Care or MMC). Effective October 1, 2015, EmblemHealth Enhanced Care plan began covering expanded Behavioral Health (BH) services for adults in New York City.
EmblemHealth Enhanced Care Prime Network providers may soon begin to see patients in a new benefit plan called EmblemHealth Enhanced Care Plus (a Health and Recovery Plan or HARP). HARP is a managed care product for adult Medicaid beneficiaries aged 21 and over, who are eligible for mainstream MMC, and meet the criteria for Serious Mental Illness (SMI) and Substance Use Disorders (SUD). Enrollment in EmblemHealth Enhanced Care Plus also began October 1, 2015.
EmblemHealth Enhanced Care Plus enrollment will be phased in, beginning with current EmblemHealth Enhanced Care plan adult enrollees in New York City who are system-identified as HARP eligible. Eligible MMC enrollees will either be passively enrolled or given an option to enroll in a HARP, depending upon current plan enrollment, as follows:
- HARP-eligible enrollees in an MMC plan operated by a Managed Care Organization (MCO) that also operates a HARP product may be passively enrolled into the HARP. The enrollment notice sent by New York Medicaid Choice (New York State’s enrollment broker) indicates HARP eligibility, the effective date of HARP enrollment and instructions on how to opt out of enrollment in the MCO’s HARP.
- HARP-eligible enrollees in MMC plans operated by an MCO not offering a HARP product may actively select and enroll in another MCO’s HARP. The notice sent by New York Medicaid Choice indicates HARP eligibility, and instructions for enrollees interested in HARP enrollment and for obtaining information regarding appropriate enrollment options.
- HIV Special Needs Plans (SNP) will cover the expanded BH benefit and all HARP services for eligible enrollees, in addition to the SNP covered benefit package. The notice sent by New York Medicaid Choice indicates the member’s HARP eligibility, HARP services that are available through the SNP, and instructions for enrollees interested in HARP enrollment. The notice also reminds consumers that some benefits covered by the SNP are not available through HARP enrollment.
It is important for EmblemHealth Enhanced Care Prime Network providers to be familiar with their network affiliations and the BH transition process to better assist consumers in understanding enrollment notices and HARP selection, and to maintain current patient relationships. Providers are encouraged to refer to the July 2015 Special Edition Medicaid Update to learn more about expansion of BH services in MMC and the services available through HARP.
Questions can be directed to:
|Division of Health Plan Contracting & Oversightfirstname.lastname@example.org|
|Office of Mental Health Customer Serviceemail@example.com|
|Office of Alcoholism and Substance Abuse Servicesfirstname.lastname@example.org|