Health Homes - FAQ

What is a Health Home?
The Health Home is a federally defined initiative in the Affordable Care Act (ACA). The initiative is designed for Medicaid recipients with multiple chronic conditions.

Health Homes are part of a person centered system of care that achieves improved outcomes and better services for recipients, as well as value for state Medicaid programs.

The Health Home is an enhanced service delivery model that promotes a better patient experience and better results than traditional care. The Health Home has many characteristics of the Patient-Centered Medical Home but is customized to meet the specific needs of Medicaid recipients with chronic medical conditions or behavioral health conditions.

Health Homes must provide 6 federally mandated  Core Services:

  • Comprehensive Care Management,
  • Care Coordination
  • Health Promotion
  • Comprehensive Transitional Care
  • Patient and Family Support
  • Referral to community and support services

Health Homes are encouraged to utilize health information technology to more efficiently and effectively coordinate the care of Health Home patients.

Through the provision of the 6 core services, the Health Home initiative aims to reduce inpatient hospitalization and emergency room visits, increase the integration between physical and behavioral health services, and enhance transitional care between institutions and the community.

What a health home is not:

  1. A Health Home is not Home Health services where a nurse or other practitioner goes in to provide services in the home.
  2. While similar, a Health Home is not a Patient Centered Medical Home.  A Health Home focuses on Medicaid Recipients with two chronic conditions, one chronic condition and at risk for a second chronic condition, mental health condition or Substance abuse issue.
  3. A Health Home is not a place where individuals reside and receive care.

How is a Health Home different that my current treatment, care or services?
The health home will offer you the support of a team instead of a single case manager. Your health home team will be concerned about your physical and your mental health. They will work with you to develop goals to help you live longer and healthier. The health home will make sure that all of your doctors and counselors are talking to one another so you can focus on getting well and staying well. Your health home will also help you to get an appointment the same day if you need it.

Why should I participate in the Health Home Program?
The Health Home program will help you with all of your health-related and other social service needs like:

  • Help you manage your medical conditions and improve your health
  • Help you prevent developing other illness or complications
  • Help you find exercise programs, learn healthy eating and lose weight
  • Help you find a family doctor, pediatrician, dentist, counselor or specialist
  • Help you and your family obtain child care, housing, transportation, and food assistance
  • Teach you and your family how to get well and stay well
  • Help you remember your doctor appointments and get there on time
  • Help you get the medications you need and take them regularly
  • Help you understand medical test results and follow doctor’s instructions
  • Help your doctors, counselors and specialists talk to each other and work together to support your recovery
  • Help answer your health questions and listen to your concerns

What if I don’t want to be in a Health Home?
You are not required to be in a Health Home.  It is your choice. If you choose not to be in a health home it does not affect your current services. However, you should discuss this with your health care provider. Being in a health home may be very helpful for you and you should consider it. If you choose not to participate either call the Department of Social Services at (605) 773-5246 or complete the Decline to Participate form found here.

Why is South Dakota implementing Health Homes?
South Dakota is implementing Health Homes to improve health outcomes and experience of care for eligible Medicaid recipients, while also realizing cost savings from better coordinated care for that population, The work began as a recommendation of the Medicaid Solutions Workgroup.  The Medicaid Solutions Workgroup, convened by Governor Dennis Daugaard during legislative session 2011,  was tasked with identifying ways Medicaid could realize cost savings and better serve recipients.   The Final Report of the Medicaid Solutions Workgroup can be viewed here: Final Reports of the Medicaid Solutions Workgroup.

In April 2012, the Department of Social Services convened a Health Home Workgroup to guide the process of evaluating and implementing Health Homes.  The Health Home Workgroup concluded its work in October 2012.  Information considered included federal requirements, other states’ Health Home models, SD Medicaid diagnostic and claims data, and other research. 

Who will be eligible for Health Homes?
South Dakota has two types of Health Homes -- those led by Primary Care Providers and those led by a Community Mental Health Centers -- to serve Medicaid recipients with complex health care needs resulting in high costs to Medicaid. Individuals who are eligible for these two health homes include:

  1. Medicaid recipients with two or more chronic conditions or recipients with one chronic condition who are at risk for a second chronic condition.

    A. Chronic conditions include: Mental Health Condition, Substance Use Disorder Asthma, COPD, Diabetes, Heart Disease, Hypertension, Obesity, Musculoskeletal and Neck/Back disorders.

    B. At-risk conditions include: Pre-Diabetes, tobacco use, Cancer, Hypercholesterolemia, Depression, and use of multiple medications (6 or more classes of drugs).
  2. Recipients who have a Severe Mental Illness or Emotional Disturbance

Why not just call it a Patient Centered Medical Home instead of a Health Home?
The Health Home terminology is the Centers for Medicaid and Medicare (CMS) driven by the Affordable Care Act (ACA).  While most of the services provide by a Health Home are similar to those provided by a patient center medical home such as comprehensive care managed, care coordination, referral to community services and a focus on Health Information Technology, they are designed to serve a different population as required by ACA.  The patient-centered medical home is population based while the Health Home focuses on Medicaid recipients.  Eligible recipients must meet eligibility requirement outlined above.

Where will Health Homes be located?
Health Homes will be located where there are qualified designated providers are willing to serve the needs of those eligible.

Who will be the providers of Health Home Services?
Each Health Home will be led by one or more designated providers.  Each designated provider will lead an individualized team of health care professionals and support staff to meet the needs of each recipient.  A designated provider team may include a health coach/care coordinator/care manager, chiropractor, pharmacist, support staff, and other services as appropriate and available.

Designated providers for primary care health homes can be primary care physicians (e.g., family practice, internal medicine, pediatrician or OB/GYN), physician’s assistants, or advanced practice nurse practitioners, working in a Federally Qualified Health Center, Rural Health Clinic or clinic group practice. 

Designated providers for behavioral health health homes include mental health professionals working in a community mental health center or other behavioral health setting.

What do I need to do to be a Health Home Provider?
Providers who would like to serve as a designated provider and feel they meet the required provider standards need to complete an application. Applications can be submitted to the Department of Social Services at any time, once the applications are reviewed and approved the Health Home team will be trained to provide the services.  A webinar on how to complete the application can be found at http://dss.sd.gov/healthhome/application.asp. New Health Homes can only come online at the beginning of a quarter.  January, April, July, and October.

How will I be reimbursed for Health Home Services?
Medical Services will be funded exactly as they are now. The Health Home provider will be paid a per-member per-month (PMPM) based on the Tier of the recipients to cover the cost of providing the 6 core services required by Health Homes.

Additional Materials