Ohio Will Launch Medicaid Health Homes for Individuals With Serious Mental Illness By June 2012
Open Minds February 27, 2012
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The Ohio Department of Mental Health (DMH) is working with community behavioral health centers (CBHCs), hospitals, and Medicaid managed care organizations (MCOs) to develop and launch a Medicaid Health Home model by June 2012 to serve adult beneficiaries with a primary diagnosis of severe and persistent mental illness (SMI) or child beneficiaries with a primary diagnosis of serious emotional disturbance. The proposed SMI Health Home model excludes beneficiaries with a primary diagnosis of developmental disability, addiction, or dementia.
The SMI Health Homes will coordinate eligible beneficiaries’ access to primary and specialty medical care, mental health care, addiction treatment, developmental disabilities services, and ancillary services and supports. Planning began in November 2011; a draft State Plan Amendment (SPA) was submitted to the federal Centers for Medicare and Medicaid Services on December 23, 2011 for informal review, with the formal submission slated for February 2012.
The plans call for the state to implement the program using a regional approach, and CBHCs will be eligible to apply to become a Medicaid Health Home. According to the draft SPA, SMI beneficiaries who currently receive care through a CBHC that qualifies as a Health Home will be pre-assigned to that CBHC for their health home. However, beneficiaries will be able to opt-out and select another qualified Health Home. Beneficiaries not connected to a CBHC Health Home, but who are identified as potentially benefitting from a CBHC health home, will be referred to one for an assessment and potential enrollment. Referrals will be based on an analysis of Medicaid claims and encounter data.
The SPA and a December 16, 2011 presentation titled “Ohio Medicaid Health Home Program Behavioral Health Leadership Group Update” emphasized that the CBHCs will receive a monthly per-person rate to provide care coordination for comprehensive medical, behavioral, long-term care, and social services. The CBHCs will also provide five core community mental health services—pharmacological management, mental health assessment, behavioral health counseling and therapy, crisis intervention behavioral health services, and community psychiatric support treatment—which will be reimbursed separately on a fee-for-service basis at the pre-existing Medicaid rate.
The core CBHC Health Home team must include the following members:
- Health Home team leader to provide administrative and clinical leadership and oversight to the Health Home team; this team member must has experience in health management, data management, managed care, and training and experience in quality improvement.
- Embedded primary care professional to provide assessment of consumer service needs, care plan development, development of treatment guidelines and monitoring patient health status and service use. This team member can be a primary care physician, a pediatrician, gynecologist, obstetrician, Certified Nurse Practitioner, or physician assistant.
- Care manager to provide overall care management and coordination for all Health Home services. This team member must have the necessary credentials and skills to conduct comprehensive assessments and treatment planning for people with SMI.
- Care manager aide to assist and support the care manager with care coordination, referrals and linkages to services, follow-up, family and consumer support, and health promotion services. This team member may be Peer Support Specialist or other health professional.
The Health Homes will be paid a monthly rate to provide the services; however the reimbursement level and methodology are still under development by workgroups formed at the end of 2011. The draft SPA noted the following general methodology:
- The monthly rate will be developed using a consistent statewide methodology based on historic claims costs for CPST as well as the Health Home team composition and caseload.
- The uniform cost report should serve as the basis for determining costs associated with Health Home services.
- The CBHC must determine caseload size, but will need to have the capacity to serve the demand in the specified region.
- Team composition can vary by the Health Home provider organization, but must be within the core team requirements.
- Payment will be contingent on the CBHC meeting core requirements set by the state; no payment will be made if the requirements are not met.
- Additional factors that could influence the monthly rate include payment for innovative ideas on how the CBHC intends to meet electronic health record requirements, share savings, growing workforce capacity, serving as a training site, exceeding benchmarks and outcome requirements, start-up costs related to equipment or information technology, or enrollment and outreach functions.
CBHC Health Homes will be required to do the following to qualify as a Health Home:
- Be certified by DMH to provide the Medicaid-covered community mental health services including pharmacological management, mental health assessment, behavioral health counseling and therapy for individual and group settings, crisis intervention behavioral health services, and community psychiatric support treatment (CPST) for individual and group settings
- Demonstrate the integration of behavioral health and primary care services by directly providing or establishing written agreements with primary care provider organizations that will provide a minimum level of medical screening and treatment services at a level to be established by the state. The written agreements must establish bi-directional integrated care.
- Establish partnerships and coordinate with other health care resources such as hospitals, medical service provider organizations, specialists (such as gynecologists, obstetricians, and addiction treatment professionals), long-term care services and support provider organizations, other provider organizations to meet beneficiaries’ needs, and managed care plans.
- Within 18 months of becoming a CBHC Health Home, obtain one or more certifications demonstrating physical and behavioral health integration from the CARF Integrated Physical Health/Behavioral Health Core Program, the Joint Commission Physical Health Standards module, the National Committee for Quality Assurance as a Patient-Centered Medical Home Level 1, or equivalent recognition standards approved by the state.
- Have capacity to receive electronic date from a variety of sources to facilitate care management, care coordination, and comprehensive transitional care; this capacity included at least clinical patient summaries with a diagnosis and medication profiles and real-time notifications of a patient’s admission to or discharge from an emergency department or inpatient facility.
- Maintain a comprehensive and continuous quality improvement program capable of collecting and reporting data on utilization and health outcomes.
A link to the full text of “Ohio Community Behavioral Health Center Health Home Program Draft State Plan Amendment” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/122311mhcdohcbhchealthhomessmi.htm.
A link to the full text of “Ohio Medicaid Health Home Program Behavioral Health Leadership Group Update” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/121611mhcdohdmhhlthhomes.htm.
For more information, contact: Trudy Sharp, Communications Director, Ohio Department of Mental Health, 30 E. Broad Street, 8th floor, Columbus, Ohio 43215-3430; 614-466-5145; E-mail: email@example.com; Web site: www.mh.state.oh.us.
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