This section provides background information on the structure and purpose of Medicaid health homes and their regulatory authority.

Resources

• • Health Home State Medicaid Director Letter (CMS/November 2010)  SMDL 10-024 Re: Health Homes for Enrollees with Chronic Conditions.
  • Health Home State Medicaid Director Letter (CMS/January 2013)  SMDL 13-001 Re: Health Home Core Quality Measures.
  • Social Security Act Sec. 1945 (March 2010)  Affordable Care Act Section 2703 – State Option to Provide Coordinated Care Through a Health Home for Individuals with Chronic Conditions.
  • Health Homes (Section 2703) Frequently Asked Questions (CMS/May 2012)  Addresses key areas for health home design, including providers, enrollment and eligibility; delivery models; quality measurement; reporting; HIT; funding and payment; and SPA/waiver authorities.
  • Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions (CMS/July 2011)  Provides an overview of the health homes opportunity.
  • “ At-a-Glance” Guide to Federal Medicaid Authorities Useful in Restructuring Medicaid Health Care Delivery or Payment(CMS/April 2012)  Summarizes Federal authorities useful in restructuring Medicaid health care delivery or payment, and that can be exercised through state plan amendments or waivers.

Developing Health Home Population Criteria

Medicaid health homes must be targeted to beneficiaries with chronic conditions or serious mental illness.  States should carefully define their target population to maximize program impact. Questions to ask include:

• How many beneficiaries would be eligible for the health home program?
• Where do beneficiaries currently receive care?
• Do eligible beneficiaries “cluster” in a certain geographic area, around certain providers, or among specific chronic conditions?
• Do subsets of the population offer opportunities for reductions in avoidable emergency department and inpatient hospital use?

Resources

• • Five Key Considerations for Exploring the Medicaid Health Homes Opportunity (CMS/October 2011)  Outlines key considerations to help states determine whether to invest in health homes and how to get started in doing so.
  • Initial Considerations to Guide the Development of Medicaid Health Homes (Center for Health Care Strategies/June 2011)  Outlines key initial considerations to guide State health-home program design, including a hands-on checklist that walks States through a list of decision points.
  • Data Analysis Considerations to Inform Medicaid Health Home Program Design (CMS/June 2012)  Guides state discussions and decisions around claims data analysis for the development of Medicaid health homes.

State-Developed Materials

• •  Department of Social and Health Services.
  • New York: Transforming Care Delivery via Health Homes for Medicaid Beneficiaries with Chronic Conditions. 
    • Webinar Slides  
    • Webinar Recording

Defining Health Home Services 

Medicaid health homes must provide six core services: (1) comprehensive care management; (2) care coordination and health promotion; (3) comprehensive transitional care/follow‐up; (4) patient and family support; and (5) referral to community and social support services and (6) use of health information technology to link services.

State-Developed Materials

• • Missouri: Community Mental Health Center Health Care Home Patient Process Narrative
  • Rhode Island: Community Mental Health Organization Health Home Process Narrative

Establishing Health Home Payment Methodologies 

States have considerable flexibility in establishing payment methodologies for Medicaid health homes. In selecting a payment method, considerations include:

• What financial incentives will help ensure that providers will deliver health home services effectively and efficiently?
• What reimbursement methods will promote accountability and flexibility?
• Will the state use a tiered reimbursement methodology based on provider capability or patient acuity?

Resources

• • ROI Forecasting Calculator for Health Homes and Medical Homes (Center for Health Care Strategies/May 2011)  Identifies the cost-savings potential of health-home or medical-home strategies through a step-by-step process. Also see companion User’s Guide.

State-Developed Materials

• • Rhode Island: CEDARR  Health Home Services and Payment Methodology: Service Crosswalk (February 2012)  Outlines health home team roles.

Meeting Health Home Quality Measurement and Reporting Requirements 

Medicaid health home programs will need to meet federal and state quality and reporting requirements. Providers of health home services will be required to report quality measures to their state as a condition for receiving payment.

Resources

• • Interim Report to Congress: Phase II Evaluation Activities (NORC-University of Chicago)  Describes the web survey, stakeholder interviews, site visits, and focus groups that are part of Phase II of the Health Home evaluation.
  • Section 2703 Health Home Long-Term Evaluation Activities (Urban Institute)  Describes the aims of the long-term Health Home evaluation and the types of data that will be collected by the evaluation team.

Using Managed Care for Health Home Implementation 

Some states may choose to create Medicaid health homes within or outside of managed care delivery systems. In developing their programs, states will need to consider the implications for health plan accreditation and non-duplication of care management services.

Resources

• • Implications of Health Homes for NCQA Health Plan Accreditation (CMS/June 2012)  Provides guidance on considerations related to National Committee for Quality Assurance health plan accreditation, particularly when the state designates primary care or other community-based providers to deliver health home services
  • Implementing Health Homes in a Risk-Based Medicaid Managed-Care Delivery System (Center for Health Care Strategies/June 2011)  Explores how states might advance their health-home strategy in whole or in part through their existing Medicaid risk-based managed-care.

State-Developed Materials

• • Massachusetts: Service Inventory of Managed Care Entities to Support Development of a Health Homes State Plan Amendment (March 2012)  Created to gather information about managed care entity’s (MCE) Care Management Services as supporting information for a state plan amendment (SPA) Application.
  • Rhode Island: Operational Protocols for Collaboration between Health Plans and Health Homes (September 2011) Outlines operational protocols for communication and care coordination between health plans and health homes for Medicaid managed care enrollees.

Integrating Physical Health/Behavioral Health in Health Homes

Medicaid health homes provide states with an important opportunity to integrate physical and behavioral health care for beneficiaries with complex care needs. Although states have considerable flexibility to define health home services and provider qualification as they see fit, effective integration of physical and behavioral health services is a critical aspect of program design. 

Resources

• • State Options for Integrating Physical and Behavioral Health Care (CMS/October 2011)  Explores state options for integrating physical and behavioral health services within managed delivery systems, including examples of current state programs and critical considerations for implementation.
  • Integrating Physical and Behavioral Health Care in Medicaid: An Online Toolkit (Center for Health Care Strategies/January 2011)  Clearinghouse of resources addressing strategies for identification, stratification, integration, consumer engagement, information exchange, and financial alignment linked to physical/behavioral health integration.
  • Webinar Resources: Integrating Physical and Behavioral Health -- An Exploration of State Options (Center for Health Care Strategies/November 2011)  Explores promising options for integrating physical and behavioral health services within coordinated delivery systems.
  • Center for Integrated Health Solutions This center, funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration, promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions.
  • Health Homes and Primary and Behavioral Health Care Integration This Substance Abuse and Mental Health Services Administration (SAMHSA) resource page includes a map of state integration efforts and guidance for states on working with SAMHSA to develop health-homes approaches prior to SPA submission. See also SAMHSA Health Reform Webinar Series.
  • Health Homes and Individuals with Behavioral Health Issues -- SAMHSA’s Guidance Document Affordable Care Act Health Home Provision (SAMHSA/September 2011)  Details key considerations for states in integrating behavioral health into health home strategies.
  • Behavioral Health Homes for People with Mental Health & Substance Use Conditions: The Core Clinical Features (Center for Integrated Health Solutions/May2012)  Report outlines a proposed set of core clinical features for behavioral health homes.