Medicaid Health Homes Initiative
The Institute is working with the West Virginia Bureau of Medical Services on a health home pilot project. Under the Affordable Care Action Section 2703, the Centers for Medicare and Medicaid Services (CMS) is offering states an option to provide health homes for members with chronic conditions, with enhanced federal support. Health Homes build on the Patient-Centered Medical Home model by providing for the enhanced integration and coordination of primary, acute, behavioral health, and long-term services and supports for persons with multiple chronic conditions or serious and persistent mental illness. The Health Homes option provides a 90% federal match for the first eight quarters of implementation for 6 health home services that have historically not been reimbursed. These include: Comprehensive care management, Care coordination, Health promotion, Comprehensive transitional care/follow-up, Patient and family support, and Referral to community and social support services. For each of these services, there is a CMS emphasis on how health information technology will be used to facilitate service provision.
The enhanced funding by CMS provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for State Medicaid programs. This provision supports CMS’s overarching approach to improving health care through the simultaneous pursuit of three goals: improving the experience of care; improving the health of populations; and reducing per capita costs of health care (without any harm whatsoever to individuals, families, or communities). To take advantage of this opportunity, states must submit a Medicaid State Plan Amendment (SPA).
West Virginia is pursuing the Health Homes opportunity with an anticipated series of State Plan Amendments that will address the chronic conditions prevalent in the state’s Medicaid population and all of which will address areas where there is significant intersection of physical and behavioral health needs. The first West Virginia SPA will focus on persons with bipolar disorder who are at risk for viral hepatitis. Participation will be limited to the six counties of Cabell, Raleigh, Mercer, Kanawha, Putnam, and Wayne. Providers in these counties will apply to serve as a health home by identifying an interdisciplinary care delivery team and demonstrating their ability to coordinate care both within the team and with other caregivers and community resources that the health home enrollees may need to access. Once an eligible Medicaid members enrolls with the health home, the health home is expected to regularly assess their physical and mental health status, coordinate appropriate care and care transitions, and report clinical outcomes that are required by CMS. A per member per month fee can be invoiced that is in addition to a standard payments already received for care activities.
The Health Improvement Institute has been assisting BMS with planning for the initial SPA, initially through convening a series of work groups to solicit stakeholder input, and then in drafting the actual SPA document to be submitted to CMS. It is anticipated that the SPA will be implemented on July 1, 2014. As of early 2014, 13 states have implemented Health Home SPAs and 2 more have submitted SPAs for approval.
For more information about the West Virginia Health Homes initiative can be found on a dedicated page on the BMS website http://www.dhhr.wv.gov/bms/Pages/WVHH.aspx.