In an effort to improve population-based care for targeted populations, integrated care models are being developed to address specific needs for Development Disabilities (DD), Behavioral Health (BH), and Long Term Services and Supports (LTSS) populations.
For DD, BH, and LTSS populations, the health home aims to ensure accountability for addressing comprehensive, person-centered needs of individuals served while improving overall population-based care management for these populations.
What is a health home?
• The Affordable Care Act of 2010, Section 2703, created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions by adding Section 1945 of the Social Security Act. CMS expects states health home providers to operate under a “whole-person” philosophy. Health Homes providers will integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person.
Who Is Eligible for a Health Home?
• Medicaid beneficiaries who:
• Have 2 or more chronic conditions
• Have one chronic condition and are at risk for a second
• Have one serious and persistent mental health condition
What services are included?
• Comprehensive care management
• Care coordination
• Health promotion
• Comprehensive transitional care/follow-up
• Patient & family support
• Referral to community & social support services
• Use of HIT to facilitate health home services
Goals of the Health Home
To deliver integrated care coordination in a manner that facilitates quality care and positive outcomes by:
• Providing integrated care coordination within and across medical health, behavioral health, long-term services and supports, and other systems
• Managing core care delivery by ensuring effective treatment of core care including pharmacy effects (i.e. chronic conditions or targeted areas of need including behavioral health, LTSS, and developmental disabilities)
While DD, BH, and LTSS health homes will all provide similar health home functions and activities, provider requirements, quality measures, and outcomes will be specific to reflect the unique needs of each population.