Specialty Mental Health Care Management Agency Attestation - Health Home Plus (HH+) for Serious Mental Illness (SMI)

Oct 2, 2026

Uploaded by nayy☆

Specialty Mental Health Care Management Agency Attestation form for designated Specialty Mental Health Care Management Agencies to serve Health Home Plus (HH+) individuals with Serious Mental Illness (SMI). The document requires agencies to submit written verification of their intent to provide Specialty Mental Health Care Management and confirm protocols for meeting OMH program standards. It references Health Home Plus for High-Need Individuals with Serious Mental Illness Program Guidance and includes fields for organization, contact, addresses, MMIS numbers, served counties, lead Health Homes, submission instructions, and certification by the CMA director.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Specialty MH CMA Standards

Submission instructions and certification

Specialty Mental Health Care Management Agency Attestation to Serve Health Home Plus Individuals with Serious Mental Illness OMH has established program standards to be met by designated Specialty Mental Health Care Management Agencies (MH CMAs) to serve the Health Home Plus ( HH+) for individuals with Serious Mental Illness (SMI) population. All fully designated Specialty MH CMAs are required to submit this written attestation verifying their intention to provide Specialty Mental Health Care Management, and to having protocols in place for ensuring compliance with the required program standards. For full details, see the “Health Home Plus for High-Need Individuals with Serious Mental Illness Program Guidance”(Re-issued December 2024). | CMA Organization Name: | | Contact Person Name & Title: | | | --- | --- | --- | --- | | Contact Person Phone: | | Contact Person E-Mail: | | | CMA Address(es)– use multiple lines to list all CMA locations, if more than one (feel free to attach separate page if needed): | | | | | | | --- | --- | --- | --- | --- | --- | | CMA Name: | | MMIS \#: | | Address: | | | Count(ies) Served: | | Lead
HHs: | | | | | CMA Name: | | MMIS \#: | | Address: | | | Count(ies) Served: | | Lead
HHs: | | | | | CMA Name: | | MMIS \#: | | Address: | | | Count(ies) Served: | | Lead
HHs: | | | | Instructions for submitting attestation to the State 1. Submit the completed attestation form via the Health Home BML: • For the Subject, select “Specialty Mental Health Care Management”. • Enter a comment, your name, email address, attach this form, and Submit. 2. Send the completed attestation form to your Lead Health Home(s) and Local Government Unit(s) via email. NYS Office of Mental Health staff will review the information provided and contact your agency if further clarification is needed. | Specialty MH CMA Standards | | | --- | --- | | | CMA has process for immediate assignment of HH+ eligible members to qualified care managers and the provision of HH+ services. | | | | | | | | | CMA has process to ensure HH+ caseload sizes do not exceed the required ratio of 1 qualified care manager for every 20 HH+ recipients. | | | | | | | | | CMA has process to ensure the minimum service intensity requirements outlined in the HH+ SMI program guidance are met. | | | | | | | | | CMA has staff meeting the HH+ SMI Staff Qualification requirements, as outlined in the HH+ SMI program guidance. | | | | | | | | | CMA has policy and procedure to ensure Supervisors and direct care management staff possess key core competencies for serving high need individuals with SMI, as outlined in HH+ SMI program guidance. | | | | | | | | | CMA has a working relationship with the LGU/SPOA in their service county; see HH+ SMI program guidance for more detail. | | | | | | | | | For CMAs authorized to serve AOT, CMA meets the additional requirements for serving AOT individuals, as outlined in HH+ SMI program guidance. | | | | | | | Certification and Acknowledgement I certify, on behalf of my agency, that all information contained in this Attestation is accurate and true. CMA Director Name (print) CMA Director Signature Signature Date

FAQs

What is the purpose of the attestation form for Specialty MH CMAs?

It verifies a designated Specialty Mental Health Care Management Agency’s intent to provide Specialty Mental Health Care Management for Health Home Plus (HH+) individuals with Serious Mental Illness (SMI) and confirms required compliance protocols are in place.

Where must the completed attestation be submitted to the State?

Submit the completed form via the Health Home BML by selecting “Specialty Mental Health Care Management,” entering a comment plus name and email, attaching the form, and submitting.

What standards must the agency demonstrate in the Specialty MH CMA Standards section?

The form requires processes for immediate assignment of HH+ eligible members to qualified care managers, maintaining HH+ caseload ratios, meeting minimum service intensity requirements, staffing qualifications, supervisory and direct care competency policies, coordination with LGU/SPOA, and additional requirements for agencies authorized to serve AOT.

Oct 2, 2026

Uploaded by nayy☆