Medicaid Health Homes. Integrated Care Conference September 25, 2013

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1 Medicaid Health Homes Integrated Care Conference September 25,

2 Outline Program Background Health Home Overview Objectives Services Eligibility Provider Eligibility Participant Eligibility Health Home Structure Staffing HIT Tools Health Home Billing 2

3 Background- Target Population Increased risk of physical health problems among those with mental illness & substance use disorders Life expectancy of 56 years among the mentally ill, vs. US average of 78 years* Complexity of multiple providers & needs Lifestyle and social determinants of health Access to care * Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics

4 Background- Health Homes Medical Homes- evolving concept since 1967 Affordable Care Act, Section Health Homes for enrollees with SPMI or multiple chronic conditions 90%FMAP for 8 quarters Behavioral Health Integration effort in Maryland Planning process began with stakeholder input Summer

5 Overview: Objectives Health Homes aim to: Further integration of behavioral and somatic care through improved care coordination and management; Improve patient outcomes, experience of care, and health care costs among individuals with chronic conditions; and Enable Health Homes to act as locus of coordination for SPMI, SED and OTP populations through provision of additional care coordination and management services. 5

6 Overview: Services Comprehensive Care Management Care Coordination Health Promotion Comprehensive Transitional Care Individual and Family Support Referral to Community and Social Support 6

7 Eligibility: Health Home Providers To become a Health Home, a provider must be licensed as a: - Psychiatric Rehabilitation Program, - Mobile Treatment Program, or - Opioid Treatment Program. Additionally, all providers must: - Be an enrolled Maryland Medicaid Provider, and - Be accredited by, or pursuing accreditation from, an approved accrediting body - Meet all Medicaid requirements including staffing levels 7

8 Eligibility: Health Home Participants The individual has been diagnosed with: serious and persistent mental illness or serious emotional disturbance meeting the medical necessity criteria for Psychiatric Rehabilitation Program (PRP) or Mobile Treatment (MT) services, OR an opioid substance use disorder treated by an opioid treatment program, AND at risk for an additional chronic condition 8

9 Health Home Structure: Staffing Health Homes must maintain the following staff levels: Health Home Director -.5 FTE/125 Enrollees Health Home Care Manager -.5 FTE/125 Enrollees - RN or PA Physician or Nurse Practitioner Consultant hours/enrollee/year Administrative Support Staff - At providers discretion 9

10 Health Home Structure: HIT Tools emedicaid online portal Providers submit initial intake and monthly report of Health Home services provided and relevant participant outcomes Allows for data entry and review, as well as reportsgenerating CRISP real-time notification of hospital encounters, pharmacy data Provider HIT system capabilities 10

11 Billing: Procedure Codes Health Home Intake- W1760 May be billed upon completion of the emedicaid intake process, informed by an initial assessment and current knowledge Monthly Health Home Service Rate- W1761 May be billed at the end of each month Must deliver and report minimum of 2 HH services to participant Submit claims within 30 days of the end of the month 11

12 Billing: emedicaid Reports Monthly report generates list of billable participants 12

13 Billing: Claims Submission Providers may submit Health Home claims directly to the Fee-For-Service system (not the ASO) using three options: HIPAA 837 claims files emedicaid s eclaims system Paper claims: CMS 1500 form 13

14 Additional information available at: %20Homes.aspx Send questions and submit provider applications to: 14

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